Healthcare Provider Details

I. General information

NPI: 1245188523
Provider Name (Legal Business Name): MICHAEL STEVEN COPPOLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 BENNER PIKE
STATE COLLEGE PA
16801-7304
US

IV. Provider business mailing address

381 BENNER PIKE
STATE COLLEGE PA
16801-7304
US

V. Phone/Fax

Practice location:
  • Phone: 814-826-6032
  • Fax:
Mailing address:
  • Phone: 814-826-6032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberF03742
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: