Individual
THERESA CROCKER COPPOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
650 PETER JEFFERSON PKWY, SUITE 160, CHARLOTTESVILLE, VA 22911-8844
(434) 293-3890
(804) 888-9567
Mailing address
650 PETER JEFFERSON PKWY, SUITE 160, CHARLOTTESVILLE, VA 22911-8844
(434) 293-3890
(804) 888-9567
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101057697
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010171181
—
VA
01
—
183570
ANTHEM BCBS
VA
01
—
306350
SOUTHERN HEALTH
VA
Enumeration date
08/12/2006
Last updated
05/22/2014
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