Provider Demographics
NPI:1790225423
Name:KOPPELMAN, MELISSA (DO)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:KOPPELMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:DE NIJS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:41 FOSTER DR
Mailing Address - Street 2:
Mailing Address - City:THORNVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43076-8010
Mailing Address - Country:US
Mailing Address - Phone:740-246-6361
Mailing Address - Fax:
Practice Address - Street 1:41 FOSTER DR
Practice Address - Street 2:
Practice Address - City:THORNVILLE
Practice Address - State:OH
Practice Address - Zip Code:43076-8010
Practice Address - Country:US
Practice Address - Phone:740-246-6361
Practice Address - Fax:740-246-5722
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.014432207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine