Provider Demographics
NPI:1184363111
Name:COPELMAYER, GUSTAVO
Entity type:Individual
Prefix:MR
First Name:GUSTAVO
Middle Name:
Last Name:COPELMAYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 MASSACHUSETTS AVE NW APT 125
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-5120
Mailing Address - Country:US
Mailing Address - Phone:202-760-8284
Mailing Address - Fax:
Practice Address - Street 1:4000 MASSACHUSETTS AVE NW APT 125
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-5120
Practice Address - Country:US
Practice Address - Phone:202-760-8284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant