Provider Demographics
NPI:1932209871
Name:COPPINGER, IMBER C (DO)
Entity Type:Individual
Prefix:DR
First Name:IMBER
Middle Name:C
Last Name:COPPINGER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 E PARK DR STE 105
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-5003
Mailing Address - Country:US
Mailing Address - Phone:740-592-4229
Mailing Address - Fax:740-592-4010
Practice Address - Street 1:26 E PARK DR STE 105
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-5003
Practice Address - Country:US
Practice Address - Phone:740-592-4229
Practice Address - Fax:740-592-4010
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.007281207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2203734Medicaid
OH2203734Medicaid
OH2203734Medicaid
OHH19464Medicare UPIN