Healthcare Provider Details

I. General information

NPI: 1225617095
Provider Name (Legal Business Name): CARLISLE MARIE TOFIL COPE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4694 BELMONT AVE
YOUNGSTOWN OH
44505-1012
US

IV. Provider business mailing address

4694 BELMONT AVE
YOUNGSTOWN OH
44505-1012
US

V. Phone/Fax

Practice location:
  • Phone: 330-480-7655
  • Fax: 330-759-3851
Mailing address:
  • Phone: 330-480-7655
  • Fax: 330-759-3851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number58.032209
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.016889
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: