Provider Demographics
NPI:1487061222
Name:SCHOPPEE, MARK C
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:SCHOPPEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 SUMMIT PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2821
Mailing Address - Country:US
Mailing Address - Phone:207-878-3691
Mailing Address - Fax:
Practice Address - Street 1:165 SUMMIT PARK AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2821
Practice Address - Country:US
Practice Address - Phone:207-878-3691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide