Provider Demographics
NPI:1508887779
Name:SCHOPPMANN, ANN MARIE R (PA)
Entity Type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:R
Last Name:SCHOPPMANN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5246
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-0246
Mailing Address - Country:US
Mailing Address - Phone:203-384-3975
Mailing Address - Fax:203-384-3829
Practice Address - Street 1:267 GRANT ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-2805
Practice Address - Country:US
Practice Address - Phone:203-384-3973
Practice Address - Fax:203-384-3829
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000222363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT970000926Medicare ID - Type Unspecified
CTS43759Medicare UPIN