Provider Demographics
NPI:1053679977
Name:COPARE, JENNIFER L (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:COPARE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:EVMS MEDICAL GROUP
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-8920
Mailing Address - Fax:757-446-5242
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 445
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-8920
Practice Address - Fax:757-446-5242
Is Sole Proprietor?:No
Enumeration Date:2012-04-28
Last Update Date:2016-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0102204183207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1053679977OtherOPTIMA HEALTH
VA1053679977OtherVIRGINIA HEALTH NETWORK
VA1053679977OtherVIRGINIA PREMIER HEALTH PLAN
NC1053679977Medicaid
VA1053679977OtherCOVENTRY NETWORK
VA1053679977Medicaid
VA1053679977OtherCORVEL
VA1053679977OtherANTHEM BC/BS
VA1053679977OtherAETNA
VA1053679977OtherUSA MANAGED CARE
VA1053679977OtherCIGNA
VA1053679977OtherUNITED HEALTHCARE
VA-028OtherTRICARE/CHAMPUS
VA1053679977OtherMULTIPLAN
NC1053679977Medicaid