Healthcare Provider Details

I. General information

NPI: 1912114976
Provider Name (Legal Business Name): COURTNEY DAWN CUPPETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8423 MARKET ST STE 207
BOARDMAN OH
44512-6778
US

IV. Provider business mailing address

8423 MARKET ST STE 207
BOARDMAN OH
44512-6778
US

V. Phone/Fax

Practice location:
  • Phone: 330-729-7901
  • Fax: 330-729-7915
Mailing address:
  • Phone: 330-729-7901
  • Fax: 330-729-7915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35.142548
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD436160
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number22658
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMD436160
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number35.142548
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: