Individual
MARIA COPELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1153 CENTRE ST, SUITE 43, JAMAICA PLAIN, MA 02130-3446
(617) 522-7041
(617) 522-3941
Mailing address
147 MILK ST, PROVIDER ENROLLMENT-9TH FLOOR, BOSTON, MA 02109-4806
(617) 559-8374
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
152897
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3170870
—
MA
Enumeration date
07/06/2006
Last updated
06/23/2011
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