Provider Demographics
NPI:1801895917
Name:COPPOLA, ANTHONY J (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:COPPOLA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:515 W STATE ROAD 434
Mailing Address - Street 2:SUITE 110A
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4981
Mailing Address - Country:US
Mailing Address - Phone:407-260-6000
Mailing Address - Fax:407-260-2133
Practice Address - Street 1:515 W STATE ROAD 434
Practice Address - Street 2:SUITE 110A
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4981
Practice Address - Country:US
Practice Address - Phone:407-260-6000
Practice Address - Fax:407-260-2133
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2020-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME54590207RG0100X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370053400Medicaid
FL370053400Medicaid
FL14749ZMedicare PIN