Healthcare Provider Details

I. General information

NPI: 1780181636
Provider Name (Legal Business Name): FRANK COPELI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2018
Last Update Date: 04/04/2024
Certification Date: 02/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 BROADWAY STE 203
REVERE MA
02151-3049
US

IV. Provider business mailing address

6501 N CHARLES ST
BALTIMORE MD
21204-6819
US

V. Phone/Fax

Practice location:
  • Phone: 443-353-9263
  • Fax:
Mailing address:
  • Phone: 443-353-9263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number285581
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number276576
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: