Provider Demographics
NPI:1275184590
Name:COPPAGE, CRISTINE MICHELLE
Entity Type:Individual
Prefix:
First Name:CRISTINE
Middle Name:MICHELLE
Last Name:COPPAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18413 BILLEK CT
Mailing Address - Street 2:
Mailing Address - City:POOLESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20837-2510
Mailing Address - Country:US
Mailing Address - Phone:301-661-7427
Mailing Address - Fax:
Practice Address - Street 1:18413 BILLEK CT
Practice Address - Street 2:
Practice Address - City:POOLESVILLE
Practice Address - State:MD
Practice Address - Zip Code:20837-2510
Practice Address - Country:US
Practice Address - Phone:301-661-7427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider