Provider Demographics
NPI:1386815892
Name:COPPOLA MEDICAL ASSOCIATES, LTD.
Entity Type:Organization
Organization Name:COPPOLA MEDICAL ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:COPPOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-725-3520
Mailing Address - Street 1:174 ARMISTICE BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-3269
Mailing Address - Country:US
Mailing Address - Phone:401-725-3520
Mailing Address - Fax:401-725-3548
Practice Address - Street 1:174 ARMISTICE BLVD STE C
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-3269
Practice Address - Country:US
Practice Address - Phone:401-725-3520
Practice Address - Fax:401-725-3548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD7964207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIE73556Medicare UPIN
RI119002643Medicare PIN