Provider Demographics
NPI:1205811254
Name:COPPOLA, MARCO (DO)
Entity type:Individual
Prefix:DR
First Name:MARCO
Middle Name:
Last Name:COPPOLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 201606
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-1606
Mailing Address - Country:US
Mailing Address - Phone:972-758-3598
Mailing Address - Fax:
Practice Address - Street 1:6800 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2422
Practice Address - Country:US
Practice Address - Phone:972-758-3598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1801207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX037149402Medicaid
TX8V2872OtherBCBS
NM13508067Medicaid
TXP00235950OtherRAILROAD
TX037149401Medicaid
TX037149403Medicaid
TX8F6638OtherBCBS
TX037149405Medicaid
TX8B2879Medicare PIN
TX8G6225Medicare PIN
TX8F6638OtherBCBS
NM13508067Medicaid
TX8B2880Medicare PIN