Provider Demographics
NPI:1295882223
Name:COPPOLA, JOYCE (MD)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:COPPOLA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 PARKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-2730
Mailing Address - Country:US
Mailing Address - Phone:401-725-3520
Mailing Address - Fax:
Practice Address - Street 1:174 ARMISTICE BLVD
Practice Address - Street 2:UNIT C
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-3269
Practice Address - Country:US
Practice Address - Phone:401-725-3520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2025-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD07964207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9002538Medicaid
RIE73556Medicare UPIN
RI007004908Medicare ID - Type Unspecified