Provider Demographics
NPI:1003803909
Name:COPPOLA, CHRISTOPHER (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:COPPOLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 37TH ST
Mailing Address - Street 2:SUITE #102
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6500
Mailing Address - Country:US
Mailing Address - Phone:772-567-4336
Mailing Address - Fax:772-567-4340
Practice Address - Street 1:1600 36TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4875
Practice Address - Country:US
Practice Address - Phone:772-217-4422
Practice Address - Fax:772-217-4460
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107664800Medicaid
FL15540Medicare PIN
FLH21098Medicare UPIN