Provider Demographics
NPI:1821194747
Name:COPPAGE, MARTHA L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:L
Last Name:COPPAGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARTHA
Other - Middle Name:L
Other - Last Name:COPPAGE-HOOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:401 YOUNGSVILLE HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5173
Mailing Address - Country:US
Mailing Address - Phone:337-330-0031
Mailing Address - Fax:337-330-0059
Practice Address - Street 1:2309 E MAIN ST
Practice Address - Street 2:SUITE G
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4046
Practice Address - Country:US
Practice Address - Phone:337-367-2001
Practice Address - Fax:337-365-3050
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2016-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.022088207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1664847Medicaid
LAG09157Medicare UPIN
LA5W337Medicare PIN