Provider Demographics
NPI:1205017605
Name:COPPA, NICHOLAS DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:DANIEL
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 1:46 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3845
Mailing Address - Country:US
Mailing Address - Phone:508-771-0006
Mailing Address - Fax:508-790-8337
Practice Address - Street 1:46 NORTH ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3845
Practice Address - Country:US
Practice Address - Phone:508-771-0006
Practice Address - Fax:508-790-8337
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD035600207T00000X
ORMD27964207T00000X
WAMD60101352207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery