Provider Demographics
NPI:1023291739
Name:DONALD P. COPLEY MD PC
Entity type:Organization
Organization Name:DONALD P. COPLEY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:COPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-874-1772
Mailing Address - Street 1:3800 DELAWARE AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1094
Mailing Address - Country:US
Mailing Address - Phone:716-874-1772
Mailing Address - Fax:716-874-6925
Practice Address - Street 1:3800 DELAWARE AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1094
Practice Address - Country:US
Practice Address - Phone:716-874-1772
Practice Address - Fax:716-874-6925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109170207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010035505OtherUNIVERA HEALTHCARE
NY2102744OtherINDEPENDENT HEALTH