Provider Demographics
NPI:1093760498
Name:COMPREHENSIVE OB/GYN CARE, INC
Entity Type:Organization
Organization Name:COMPREHENSIVE OB/GYN CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:A. MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COPPA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-946-4022
Mailing Address - Street 1:725 RESERVOIR AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4448
Mailing Address - Country:US
Mailing Address - Phone:401-946-4022
Mailing Address - Fax:401-946-4077
Practice Address - Street 1:725 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4448
Practice Address - Country:US
Practice Address - Phone:401-946-4022
Practice Address - Fax:401-946-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIC046405Medicaid
RI169081095Medicare PIN
RIC046405Medicaid