Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | D0068536 | MD |
NPI | 1033253471 |
---|---|
Provider Name | Angela M. Kopack |
First Address | Columbia, MD 21044-2896 |
Second Address | Columbia, MD 21044-2896 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2007 |
Last Update Date | 28/06/2009 |