Provider Demographics
NPI:1568460210
Name:COPPULA, WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:COPPULA
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 1:9795 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9700
Mailing Address - Country:US
Mailing Address - Phone:412-366-7337
Mailing Address - Fax:412-366-5118
Practice Address - Street 1:9795 PERRY HWY STE 100
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9700
Practice Address - Country:US
Practice Address - Phone:412-366-7337
Practice Address - Fax:412-366-5118
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025886E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010378290008Medicaid
B41776Medicare UPIN