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General NPI Number Information
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NPI Number | 1174504609
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Entity Type | Individual
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Provider Name | SARAH M COPPOLINO PA
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Gender | Female
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 11/13/2013
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Provider Practice Location Address
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Address Line | 10441 MONCREIFFE RD SUITE 101
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City | RALEIGH
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State | NC
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Zip | 27617-7810
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Country | US
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Telephone | 800-266-3853
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 63362
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City | CHARLOTTE
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State | NC
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Zip | 28263-3362
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Country | US
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Telephone | 919-684-8111
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2320
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-04355
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License Number State | NC
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