Healthcare Provider Details

I. General information

NPI: 1306306451
Provider Name (Legal Business Name): NAA AKAWA KOPPOE-CLARKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STACY KOPPOE MD

II. Dates (important events)

Enumeration Date: 03/24/2019
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 COLISEUM DR STE 300
HAMPTON VA
23666-6257
US

IV. Provider business mailing address

4001 COLISEUM DR STE 300
HAMPTON VA
23666-6257
US

V. Phone/Fax

Practice location:
  • Phone: 757-827-2025
  • Fax:
Mailing address:
  • Phone: 757-827-2025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number0101278732
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351048892
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101278732
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: