Individual
JOHN COPPOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
267 GRANT ST, BRIDGEPORT, CT 06610-2805
(203) 384-3075
Mailing address
267 GRANT ST, BRIDGEPORT, CT 06610-2805
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XGC0683M49824
ANTHEM BLUE CROSS
CT
Enumeration date
07/14/2017
Last updated
07/14/2017
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