Provider Demographics
NPI:1376506055
Name:COMMUNITY CARE PLUS
Entity Type:Organization
Organization Name:COMMUNITY CARE PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:COPPOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-367-3121
Mailing Address - Street 1:PO BOX 16008
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15242-0008
Mailing Address - Country:US
Mailing Address - Phone:412-920-5860
Mailing Address - Fax:412-920-5861
Practice Address - Street 1:601 MONROE AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15202-3520
Practice Address - Country:US
Practice Address - Phone:412-920-5860
Practice Address - Fax:412-920-5861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016005720007Medicaid
PA888998OtherBLUESHIELD
PA888998OtherBLUESHIELD