Provider Demographics
NPI:1356662753
Name:COPERTINO, LEONARD MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:MICHAEL
Last Name:COPERTINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 TANNER WAY STE 220
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-8332
Mailing Address - Country:US
Mailing Address - Phone:865-882-2442
Mailing Address - Fax:
Practice Address - Street 1:1855 TANNER WAY STE 220
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-8332
Practice Address - Country:US
Practice Address - Phone:865-882-2442
Practice Address - Fax:865-374-2123
Is Sole Proprietor?:No
Enumeration Date:2010-06-20
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD24085208600000X
TN72147208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ096515Medicaid
NY04547839Medicaid