Healthcare Provider Details

I. General information

NPI: 1720047103
Provider Name (Legal Business Name): STANFORD COPLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2157 MAIN ST
BUFFALO NY
14214-2648
US

IV. Provider business mailing address

2157 MAIN ST
BUFFALO NY
14214-2648
US

V. Phone/Fax

Practice location:
  • Phone: 716-862-1501
  • Fax:
Mailing address:
  • Phone: 716-862-1501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number089969
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: