Individual
BERT ANTHONY COPPOTELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2 LEE RD, LISBON, CT 06351-3015
(860) 376-4451
(860) 376-5977
Mailing address
2 LEE RD, LISBON, CT 06351-3015
(860) 376-4451
(860) 376-5977
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
26684
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001266840
—
CT
01
—
00126684004
BCBS
—
01
—
010621809
TID#
—
01
—
2V1389
HEALTHNET
—
Enumeration date
06/01/2005
Last updated
09/05/2007
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