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Organization
COPPIN STATE UNIVERSITY
Active
Organization
COPPIN STATE UNIVERSITY
Active
Other names
CSU Community Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHAVON T. LEGETTE CRNP (ASSOCIATE DIRECTOR)
(410) 951-4188
Entity
Organization
Contact information
Practice address
2500 W NORTH AVE, SUITE 131, BALTIMORE, MD 21216-3633
(410) 951-4188
Mailing address
2601 W. NORTH AVENUE, SUITE 131, BALTIMORE, MD 21216
(410) 951-4188
(410) 951-6158
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
216200700
—
MD
05
—
216500700
—
MD
Enumeration date
09/19/2007
Last updated
02/22/2013
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