Healthcare Provider Details

I. General information

NPI: 1831423607
Provider Name (Legal Business Name): MARIANNA RIVAS-COPPOLA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 ADAMS AVE SUITE L400
MEMPHIS TN
38103-2816
US

IV. Provider business mailing address

51 N DUNLAP ST SUITE G145
MEMPHIS TN
38105-4625
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-7337
  • Fax:
Mailing address:
  • Phone: 901-287-5928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number54257
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: