Individual
DAGAN EDRICK COPPOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1427 VINE ST, PHILADELPHIA, PA 19102-1031
(215) 762-2530
Mailing address
1427 VINE ST, PHILADELPHIA, PA 19102-1031
(215) 762-2530
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD455203
PA
207RI0200X
Infectious Disease Physician
Primary
MD455203
PA
Other
Enumeration date
12/03/2007
Last updated
12/02/2019
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