Provider Demographics
NPI:1922006311
Name:PAUL J. COPPOLA, MD, PC
Entity Type:Organization
Organization Name:PAUL J. COPPOLA, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:COPPOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-245-8035
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:STE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02871Medicare ID - Type Unspecified
CTC02871Medicare PIN