Basic Information
Provider Information
NPI: 1003011404
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCCOPPIN
FirstName: HOLLY
MiddleName: HARE
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 741337
Address2:  
City: ATLANTA
State: GA
PostalCode: 303741337
CountryCode: US
TelephoneNumber: 9134690503
FaxNumber: 9134695267
Practice Location
Address1: 10600 MASTIN ST
Address2:  
City: OVERLAND PARK
State: KS
PostalCode: 662125723
CountryCode: US
TelephoneNumber: 9134696447
FaxNumber: 9133381311
Other Information
ProviderEnumerationDate: 06/18/2007
LastUpdateDate: 12/31/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207N00000X2007016662MON Allopathic & Osteopathic PhysiciansDermatology 
207ND0101X63895GAN Allopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
207ND0101X04-34976KSY Allopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery

No ID Information.


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