MEDICARE: DEVIN COPPOLA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	201412-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306885108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVIN COPPOLA MD

Provider Business Mailing Address
First Line	:	PO BOX 340
Second Line	:
City	:	NEW HARTFORD
State	:	NY
Zip	:	13413-0340
Country	:	US
Telephone Number	:	315-732-9368
Fax Number	:	315-732-9403

Provider Business Practice Location Address
First Line	:	4615 NORTH ST
Second Line	:
City	:	JAMESVILLE
State	:	NY
Zip	:	13078-9499
Country	:	US
Telephone Number	:	315-469-7600
Fax Number	:	315-469-7775

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	03/07/2023

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