Provider Demographics
NPI:1528022944
Name:COPPOLA, MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:COPPOLA
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 1:601 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15202-3520
Mailing Address - Country:US
Mailing Address - Phone:412-734-3030
Mailing Address - Fax:412-734-9525
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:412-734-3030
Practice Address - Fax:412-734-9525
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD047386L207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012892540002Medicaid
PA0012892540002Medicaid
PA725466Medicare PIN