MEDICARE: DR. LEONARD MICHAEL COPERTINO M.D.

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	208600000X	Surgery Physician	MD24085	ME
2	208600000X	Surgery Physician	72147	TN

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356662753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONARD MICHAEL COPERTINO M.D.

Provider Business Mailing Address
First Line	:	1855 TANNER WAY STE 220
Second Line	:
City	:	HARRIMAN
State	:	TN
Zip	:	37748-8332
Country	:	US
Telephone Number	:	865-882-2442
Fax Number	:

Provider Business Practice Location Address
First Line	:	1855 TANNER WAY STE 220
Second Line	:
City	:	HARRIMAN
State	:	TN
Zip	:	37748-8332
Country	:	US
Telephone Number	:	865-882-2442
Fax Number	:	865-374-2123

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

Provider Enumeration Date	:	06/20/2010
Last Update Date	:	10/03/2024

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