Provider Demographics
NPI:1053838623
Name:COUPAL, TYLER MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:MICHAEL
Last Name:COUPAL
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 1:55 FRUIT ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2696
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT STREET, YAWKEY 6E
Practice Address - Street 2:MUSCULOSKELETAL IMAGING, MASSACHUSETTS GENERAL HOSPITAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-7717
Practice Address - Fax:617-726-5282
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2019-06-28
Deactivation Date:2018-03-29
Deactivation Code:
Reactivation Date:2019-06-14
Provider Licenses
StateLicense IDTaxonomies
MA2734812085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology