Provider Demographics
NPI:1528003977
Name:COPPOLA, ANGELO G JR (MD)
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:G
Last Name:COPPOLA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26618
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72221-6601
Mailing Address - Country:US
Mailing Address - Phone:501-313-5200
Mailing Address - Fax:501-747-2868
Practice Address - Street 1:10915 N RODNEY PARHAM RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212
Practice Address - Country:US
Practice Address - Phone:501-747-2828
Practice Address - Fax:501-406-9265
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2020-01-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARE0654207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR131799001Medicaid
AR131799001Medicaid
AR5K507Medicare ID - Type Unspecified