Provider Demographics
NPI:1255461794
Name:BERNARD G COPPOLELLI DPM, INC
Entity type:Organization
Organization Name:BERNARD G COPPOLELLI DPM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:COPPOLELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:401-828-1811
Mailing Address - Street 1:134 SANDY BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-5864
Mailing Address - Country:US
Mailing Address - Phone:401-828-1811
Mailing Address - Fax:401-823-0065
Practice Address - Street 1:134 SANDY BOTTOM RD
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-5864
Practice Address - Country:US
Practice Address - Phone:401-828-1811
Practice Address - Fax:401-823-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI5219530001Medicare NSC
RI709003634Medicare PIN