Healthcare Provider Details

I. General information

NPI: 1376506055
Provider Name (Legal Business Name): COMMUNITY CARE PLUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MONROE AVE
PITTSBURGH PA
15202-3520
US

IV. Provider business mailing address

PO BOX 16008
PITTSBURGH PA
15242-0008
US

V. Phone/Fax

Practice location:
  • Phone: 412-920-5860
  • Fax: 412-920-5861
Mailing address:
  • Phone: 412-920-5860
  • Fax: 412-920-5861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: DR. MATTHEW J COPPOLA
Title or Position: OWNER
Credential: M.D.
Phone: 412-367-3121