Healthcare Provider Details

I. General information

NPI: 1083758783
Provider Name (Legal Business Name): PAMELA S COPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 W LITTLETON BLVD SUITE #100
LITTLETON CO
80120-2368
US

IV. Provider business mailing address

6252 W CROSS DR
LITTLETON CO
80123-5123
US

V. Phone/Fax

Practice location:
  • Phone: 303-730-1313
  • Fax:
Mailing address:
  • Phone: 303-548-5031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25617
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: