Healthcare Provider Details

I. General information

NPI: 1760581821
Provider Name (Legal Business Name): GEORGE LEE COPPIT III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 RIDGELY AVE STE 110
ANNAPOLIS MD
21401-1082
US

IV. Provider business mailing address

600 RIDGELY AVE STE 110
ANNAPOLIS MD
21401-1082
US

V. Phone/Fax

Practice location:
  • Phone: 410-573-9191
  • Fax: 410-573-5910
Mailing address:
  • Phone: 410-573-9191
  • Fax: 410-573-5910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberD0065006
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: