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General NPI Number Information
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NPI Number | 1316952609
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Entity Type | Individual
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Provider Name | KRISTIE A KOPPENHEFFER M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | LONGWOOD PEDIATRICS, LLP 319 LONGWOOD AVENUE
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City | BOSTON
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State | MA
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Zip | 02115
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Country | US
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Telephone | 617-277-7320
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Fax |
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Provider Business Mailing Address
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Address Line | 7 HARVARD SQ APT.# 3B
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City | BROOKLINE
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State | MA
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Zip | 02445-7684
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Country | US
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Telephone | 617-277-7320
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 228961
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License Number State | MA
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