Basic Information
| Provider Information | |||||||||
| NPI: | 1932209871 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COPPINGER | ||||||||
| FirstName: | IMBER | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26 E PARK DR STE 105 | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457015003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405924229 | ||||||||
| FaxNumber: | 7405924010 | ||||||||
| Practice Location | |||||||||
| Address1: | 26 E PARK DR STE 105 | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457015003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405924229 | ||||||||
| FaxNumber: | 7405924010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 10/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34.007281 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2203734 | 05 | OH | MEDICAID |