Healthcare Provider Details

I. General information

NPI: 1659565166
Provider Name (Legal Business Name): MARIA T KOPICKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 COUNTRY CORNERS RD
AMHERST MA
01002-3317
US

IV. Provider business mailing address

65 COUNTRY CORNERS RD
AMHERST MA
01002-3317
US

V. Phone/Fax

Practice location:
  • Phone: 413-256-2316
  • Fax:
Mailing address:
  • Phone: 413-256-2316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number157586
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: