Provider Demographics
NPI:1265466494
Name:MARGUERITE L. COPPENS, MD
Entity Type:Organization
Organization Name:MARGUERITE L. COPPENS, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARGUERITE
Authorized Official - Middle Name:L
Authorized Official - Last Name:COPPENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-632-4045
Mailing Address - Street 1:565 N FOREST RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4935
Mailing Address - Country:US
Mailing Address - Phone:716-632-4045
Mailing Address - Fax:716-632-6908
Practice Address - Street 1:565 N FOREST RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-4935
Practice Address - Country:US
Practice Address - Phone:716-632-4045
Practice Address - Fax:716-632-6908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158086-1207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDO2286Medicare UPIN