Mark Andrew Koup, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS036484 Issued in PA

Practice address

325 Central Ave
Suite 101
Malvern, PA 19355-3219

Phone

(610) 644-0408

Fax

(610) 647-1024

NPI assigned

Nov 1, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 12, 2016 through Jul 12, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mark Carpenter Military Dental Service, LLC.

  • Dental Clinic/Center
  • Paoli, PA
  • NPI 1396619193
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1750468856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 CENTRAL AVE",
            "address_2": "SUITE 101",
            "city": "MALVERN",
            "state": "PA",
            "postal_code": "193553219",
            "telephone_number": "610-644-0408",
            "fax_number": "610-647-1024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 CENTRAL AVE",
            "address_2": "SUITE 101",
            "city": "MALVERN",
            "state": "PA",
            "postal_code": "193553219",
            "telephone_number": "610-644-0408",
            "fax_number": "610-647-1024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOUP",
        "first_name": "MARK",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS036484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kohlerman Pharmacy Inc
• Amber Lynn Kohls
• Emily A Koop, MSOTR
• Abass Koroma
• Rupal Kothari, D.O.
• Richard Frederick Koup, D.M.D.
• Victoria Kramp, OTR/L
• John J Kraus, MD
• Haley Kreft, RD, LDN
• Brian Scott Kriebel, DPT

• General Practice Dentistry in Malvern, PA
• Providers in Malvern, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.