Provider Demographics
NPI:1598763997
Name:COPPOLA, PAUL J (MD)
Entity Type:Individual
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First Name:PAUL
Middle Name:J
Last Name:COPPOLA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:340 MAIN ST
Mailing Address - Street 2:STE 670
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1604
Mailing Address - Country:US
Mailing Address - Phone:508-754-3566
Mailing Address - Fax:508-438-6364
Practice Address - Street 1:145 DURHAM RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2674
Practice Address - Country:US
Practice Address - Phone:203-245-8035
Practice Address - Fax:203-245-4315
Is Sole Proprietor?:No
Enumeration Date:2005-07-09
Last Update Date:2011-10-05
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Provider Licenses
StateLicense IDTaxonomies
CT015953207VG0400X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001159532Medicaid
CT001159532Medicaid
B84171Medicare UPIN
CT160000318Medicare PIN