Provider Demographics
NPI:1023006681
Name:COPPOLA, CARL D (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:D
Last Name:COPPOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-0325
Mailing Address - Fax:
Practice Address - Street 1:3950 KRESGE WAY STE 402
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-5914
Practice Address - Country:US
Practice Address - Phone:502-893-3683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28995207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2862OtherBCBS
KY64289952Medicaid
KY000000045699OtherANTHEM
KY1052620OtherPASSPORT
KY040011473OtherRAILROAD MEDICARE
KYF11324Medicare UPIN
KY000000045699OtherANTHEM