Basic Information
| Provider Information | |||||||||
| NPI: | 1205279734 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COPENHAVER | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 830 PENNSYLVANIA AVE STE 103 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253023389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043881552 | ||||||||
| FaxNumber: | 3043881565 | ||||||||
| Practice Location | |||||||||
| Address1: | 830 PENNSYLVANIA AVE STE 103 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253023389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043881552 | ||||||||
| FaxNumber: | 3043881565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2013 | ||||||||
| LastUpdateDate: | 07/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 31296 | WV | N | Allopathic & Osteopathic Physicians | Hospitalist | 208000000X | 31296 | WV | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.