Provider Demographics
NPI:1558369041
Name:COPPAGE, KRISTIN (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:COPPAGE
Suffix:
Gender:F
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:PO BOX 9493
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-9493
Mailing Address - Country:US
Mailing Address - Phone:513-862-6200
Mailing Address - Fax:513-862-4358
Practice Address - Street 1:375 DIXMYTH AVE
Practice Address - Street 2:8TH FLOOR
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2475
Practice Address - Country:US
Practice Address - Phone:513-862-6200
Practice Address - Fax:513-862-4358
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35484207VM0101X
OH35076830C207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2315131Medicaid
OH4073642Medicare PIN
OH2315131Medicaid
KY0357106Medicare PIN
OHH58566Medicare UPIN
OH4073643Medicare PIN