MEDICARE: ANTHONY J 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	207RG0100X	Gastroenterology Physician	ME54590	FL
2	174400000X	Specialist	ME54590	FL

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	:	1801895917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY J COPPOLA MD

Provider Business Mailing Address
First Line	:	515 W STATE ROAD 434
Second Line	:	SUITE 110A
City	:	LONGWOOD
State	:	FL
Zip	:	32750-4981
Country	:	US
Telephone Number	:	407-260-6000
Fax Number	:	407-260-2133

Provider Business Practice Location Address
First Line	:	515 W STATE ROAD 434
Second Line	:	SUITE 110A
City	:	LONGWOOD
State	:	FL
Zip	:	32750-4981
Country	:	US
Telephone Number	:	407-260-6000
Fax Number	:	407-260-2133

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	08/29/2020

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