Provider Demographics
NPI:1316952609
Name:KOPPENHEFFER, KRISTIE A (MD)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:A
Last Name:KOPPENHEFFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7 HARVARD SQ
Mailing Address - Street 2:APT.# 3B
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7684
Mailing Address - Country:US
Mailing Address - Phone:617-277-7320
Mailing Address - Fax:
Practice Address - Street 1:LONGWOOD PEDIATRICS, LLP
Practice Address - Street 2:319 LONGWOOD AVENUE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-277-7320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA228961208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics