Provider Demographics
NPI:1114964251
Name:COPPA, A. MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:A. MICHAEL
Middle Name:
Last Name:COPPA
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 1:725 RESERVOIR AVE
Mailing Address - Street 2:
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
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA257798207V00000X
RIMD08249208VP0000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7003554Medicaid
RI007010108Medicare ID - Type Unspecified
RIF68223Medicare UPIN