Basic Information
| Provider Information | |||||||||
| NPI: | 1538141601 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COPPENS | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 IRONGATE CENTER | ||||||||
| Address2: | |||||||||
| City: | GLENS FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128013471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187934409 | ||||||||
| FaxNumber: | 5187935886 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 IRONGATE CENTER | ||||||||
| Address2: | |||||||||
| City: | GLENS FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128013471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187934409 | ||||||||
| FaxNumber: | 5187935886 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2005 | ||||||||
| LastUpdateDate: | 02/13/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 181652 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000401237001 | 01 | NY | BLUE SHIELD WNY | OTHER | CD1981 | 01 | RAILROAD MEDICARE GROUP # | OTHER | 002120070020 | 01 | NY | FIDELIS | OTHER | 5639199 | 01 | NY | AETNA | OTHER | 08159 | 01 | NY | MVP | OTHER | 10492712 | 01 | NY | CAQH | OTHER | 56402A | 01 | MEDICARE GROUP NUMBER | OTHER | 79F711 | 01 | NY | BLUE CROSS BLUE SHIELD | OTHER | NY22884 | 01 | NY | TRICARE | OTHER | 000401237001 | 01 | NY | BLUE SHIELS NENY | OTHER | 01234835 | 05 | NY | MEDICAID | 56402A | 01 | NY | MEDICARE GROUP NUMBER | OTHER | 00020889501 | 01 | NY | UNIVERA | OTHER | 10000396 | 01 | NY | CDPHP | OTHER | 46978 | 01 | NY | GHI HMO | OTHER | 5900204 | 01 | NY | GHI | OTHER |