Individual
MIRANDA L KOPNISKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
585 LEBANON ST, MELROSE, MA 02176-3225
(781) 979-3635
Mailing address
585 LEBANON ST, MELROSE, MA 02176-3225
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA4046
MA
Other
Enumeration date
09/29/2010
Last updated
10/24/2012
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