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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