Provider Demographics
NPI:1730729047
Name:FREEMAN-COPPADGE, DARREN J (PHD, PHARMD, BCPP)
Entity type:Individual
Prefix:DR
First Name:DARREN
Middle Name:J
Last Name:FREEMAN-COPPADGE
Suffix:
Gender:M
Credentials:PHD, PHARMD, BCPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 WEST ST
Mailing Address - Street 2:SUITE 607
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-4198
Mailing Address - Country:US
Mailing Address - Phone:240-994-6346
Mailing Address - Fax:
Practice Address - Street 1:1125 WEST ST
Practice Address - Street 2:SUITE 607
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4198
Practice Address - Country:US
Practice Address - Phone:443-832-6750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06215103TC1900X
MD177261835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No1835P1300XPharmacy Service ProvidersPharmacistPsychiatric