Breland Juwan Cospy
Individual provider Active NPI Driver · Trotwood, OH
NPI 1043979412 · NPPES record last updated Dec 14, 2021
Key facts
- NPI
- 1043979412
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- UH298850 (OH)
- Practice address
- 317 Stubbs Dr
Trotwood, OH 45426-3160 - Phone
- (937) 815-4673
- NPI assigned
- Dec 14, 2021
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| UH298850 | OH | MD | Driver |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver |
172A00000X | UH298850 | OH | Yes |
Addresses
Primary practice location
317 Stubbs Dr
Trotwood, OH 45426-3160
Mailing address
317 Stubbs Dr
Trotwood, OH 45426-3160
Phone (937) 815-4673
Other providers in Trotwood, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 14, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.