Provider Demographics
NPI:1518122779
Name:COPPOLINO, WHITNEY (MD)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:COPPOLINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2696
Mailing Address - Country:US
Mailing Address - Phone:866-644-8910
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:866-644-8910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-26
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA268553207RC0000X
NH17752207RC0000X, 207RC0000X
MA264005207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3105822Medicaid
NJ0265608Medicaid
PA102611985Medicaid
PA102611985Medicaid