Provider Demographics
NPI:1508326455
Name:COUPERUS-MASHEWSKE, CODY (MD)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:COUPERUS-MASHEWSKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CODY
Other - Middle Name:
Other - Last Name:COUPERUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:22 S GREENE ST RM N3E09
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1544
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 S GREENE ST RM N3E09
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program