Provider Demographics
NPI:1538141601
Name:COPPENS, THOMAS B (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:B
Last Name:COPPENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 IRONGATE CENTER
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-3471
Mailing Address - Country:US
Mailing Address - Phone:518-793-4409
Mailing Address - Fax:518-793-5886
Practice Address - Street 1:3 IRONGATE CENTER
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3471
Practice Address - Country:US
Practice Address - Phone:518-793-4409
Practice Address - Fax:518-793-5886
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181652207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000401237001OtherBLUE SHIELD WNY
CD1981OtherRAILROAD MEDICARE GROUP #
NY002120070020OtherFIDELIS
NY5639199OtherAETNA
NY08159OtherMVP
NY10492712OtherCAQH
56402AOtherMEDICARE GROUP NUMBER
NY79F711OtherBLUE CROSS BLUE SHIELD
NYNY22884OtherTRICARE
NY000401237001OtherBLUE SHIELS NENY
NY01234835Medicaid
NY56402AOtherMEDICARE GROUP NUMBER
NY00020889501OtherUNIVERA
NY10000396OtherCDPHP
NY46978OtherGHI HMO
NY5900204OtherGHI
NY08159OtherMVP
NY10000396OtherCDPHP