Healthcare Provider Details

I. General information

NPI: 1306885108
Provider Name (Legal Business Name): DEVIN COPPOLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 NORTH ST
JAMESVILLE NY
13078-9499
US

IV. Provider business mailing address

PO BOX 340
NEW HARTFORD NY
13413-0340
US

V. Phone/Fax

Practice location:
  • Phone: 315-469-7600
  • Fax: 315-469-7775
Mailing address:
  • Phone: 315-732-9368
  • Fax: 315-732-9403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number201412-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: