Provider Demographics
NPI:1134116239
Name:COPPEL, LEWIS WILLIAM JR (MD)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:WILLIAM
Last Name:COPPEL
Suffix:JR
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 1:6857 NEW ALBANY CONDIT RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-8573
Mailing Address - Country:US
Mailing Address - Phone:614-855-1114
Mailing Address - Fax:
Practice Address - Street 1:6857 NEW ALBANY CONDIT RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-8573
Practice Address - Country:US
Practice Address - Phone:614-855-1114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35039570C207P00000X
OH35.039570207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCO047245Medicare ID - Type Unspecified
C01774Medicare UPIN