| Bert Coppotelli Md Llc | |
|
2 Lee Rd Lisbon CT 06351-3015 | |
| (860) 376-4451 | |
| (860) 376-5977 |
| Full Name | Bert Coppotelli Md Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2 Lee Rd, Lisbon, Connecticut |
| Authorized Official Name and Position | Bert Anthony Coppotelli (OWNER) |
| Authorized Official Contact | 8603764451 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bert Coppotelli Md Llc 2 Lee Rd Lisbon CT 06351-3015 Ph: (860) 376-4451 | Bert Coppotelli Md Llc 2 Lee Rd Lisbon CT 06351-3015 Ph: (860) 376-4451 |
| NPI Number | 1699969469 |
|---|---|
| Provider Enumeration Date | 09/05/2007 |
| Last Update Date | 09/05/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699969469 | NPI | - | NPPES |
| 001266840 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 26684 (Connecticut) | Primary |
Mark D. Deponte, M.d.,llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2 Lee Rd, Lisbon, CT 06351 Phone: 860-376-4451 Fax: 860-376-5977 |