MEDICARE: TONY COPLIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	385H00000X	Respite Care	68953601	PA
2	376J00000X	Homemaker	68953601	PA
3	376K00000X	Nurse's Aide	68953601	PA

General Provider Information

NPI Number	:	1003510439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONY COPLIN

Provider Business Mailing Address
First Line	:	5334 N SYDENHAM ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19141-1620
Country	:	US
Telephone Number	:	267-734-6853
Fax Number	:

Provider Business Practice Location Address
First Line	:	5334 N SYDENHAM ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19141-1620
Country	:	US
Telephone Number	:	267-734-6853
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2023
Last Update Date	:	03/29/2023

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Directions to “ TONY COPLIN ” Practice Location

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