MEDICARE: KRISTIN COPPAGE MD

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	207VM0101X	Maternal & Fetal Medicine Physician	35484	KY
2	207VM0101X	Maternal & Fetal Medicine Physician	35076830C	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558369041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN COPPAGE MD

Provider Business Mailing Address
First Line	:	PO BOX 9493
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-9493
Country	:	US
Telephone Number	:	513-862-6200
Fax Number	:	513-862-4358

Provider Business Practice Location Address
First Line	:	375 DIXMYTH AVE
Second Line	:	8TH FLOOR
City	:	CINCINNATI
State	:	OH
Zip	:	45220-2475
Country	:	US
Telephone Number	:	513-862-6200
Fax Number	:	513-862-4358

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	11/15/2019

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Directions to “ KRISTIN COPPAGE MD” Practice Location

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