Organization
BERT COPPOTELLI MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BERT ANTHONY COPPOTELLI MD (OWNER)
(860) 376-4451
Entity
Organization
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
Enumeration date
09/05/2007
Last updated
09/05/2007
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