BERT ANTHONY COPPOTELLI (NPI# 1629070941) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629070941 |
| Entity Type | Individual |
| Full Name | BERT ANTHONY COPPOTELLI |
| Credential | MD |
| Practice Address |
2 Lee Rd Lisbon CT 06351-3015 |
| Practice Telephone | 8603764451 |
| Practice Fax Number | 8603765977 |
| Mailing Telephone | 8603764451 |
| Mailing Fax Number | 8603765977 |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2007-09-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 26684 | CT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UNHC | 010621809 | 01 | |
| CT | 001266840 | 05 | |
| TID# | 010621809 | 01 | |
| BCBS | 00126684004 | 01 | |
| CIGNA | 010621809 | 01 | |
| HEALTHNET | 2V1389 | 01 |
| Street Address |
2 LEE RD |
| City | LISBON |
| State | CT |
| Zip Code | 06351-3015 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548591597 | Mark D. Deponte, M.d.,llc | Family Medicine | 2 Lee Rd, Lisbon, CT 06351-3015 | 2010-01-14 |
| 1699969469 | Bert Coppotelli Md LLC | Family Medicine | 2 Lee Rd, Lisbon, CT 06351-3015 | 2007-09-05 |
| 1265434583 | Mark David Deponte | Family Medicine | 2 Lee Rd, Lisbon, CT 06351 | 2005-06-01 |
| 1700888021 | Cynthia Booth Lord | Physician Assistant | 2 Lee Rd, Lisbon, CT 06351 | 2005-06-01 |
| 1528060845 | Melanie I Hopkins | Physician Assistant | 2 Lee Rd, Lisbon, CT 06351 | 2005-06-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659617058 | Erin Haggan | Social Worker | 55 Dina Ln, Griswold, CT 06351 | 2012-12-13 |
| 1750554788 | Lisbon Central School | Local Education Agency (LEA) | 15 Newent Road, Lisbon, CT 06351 | 2008-04-10 |
| 1699953729 | Joel Zuckerbraun Odpl | Optometrist | 8 North Main Street, Jewett City, CT 06351 | 2008-01-31 |
| 1275542219 | Eastern Connecticut Rehabilitation Centers | Clinic/Center | 2 B Lee Road, Lisbon, CT 06351 | 2006-08-07 |
| 1841260106 | Sasha B Campbell | Physical Therapist | 2b Lee Road, Lisbon, CT 06351 | 2006-01-26 |
| 1316296502 | Kelsey Lyn Joslyn | Counselor | 226 E Main St, Griswold, CT 06351 | 2012-09-04 |
| 1124183660 | Jason Edward Cavanaugh | Optometrist | 180 River Rd, Lisbon, CT 06351 | 2006-12-26 |
| 1952310955 | Penny Anne Allyn | Physical Therapist | 2b Lee Road, Lisbon, CT 06351 | 2006-08-07 |
| 1578572574 | Audrey Jo Traylor | Physical Therapist | 2b Lee Road, Lisbon, CT 06351 | 2006-08-07 |
| 1588114870 | Whole Self Wellness, LLC | Clinic/Center | 144 Banjo Sullivan Rd, Griswold, CT 06351-1201 | 2016-10-11 |
| Find all providers in zip 06351 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104370519 | Ritika Sharma | Family Medicine | 330 N Market St Ste B, Lisbon, OH 44432-1146 | 2016-08-15 |
| 1720067200 | Stephen Fairchild | Family Medicine | 2 Bisbee St, Lisbon, ME 04250-6835 | 2006-01-12 |
| 1922085612 | Randall L Hinrichs | Family Medicine | 23708 Cedar Jones Rd, Lisbon, IA 52253-9027 | 2005-12-23 |
| 1861478356 | Iram F Ahmed | Family Medicine | 7880 Lincole Pl, Lisbon, OH 44432-8322 | 2005-12-16 |
| 1548591597 | Mark D. Deponte, M.d.,llc | Family Medicine | 2 Lee Rd, Lisbon, CT 06351-3015 | 2010-01-14 |
| 1629202676 | Joanna Rulf | Family Medicine | 2 Bisbee St, Lisbon, ME 04250-6835 | 2009-05-06 |
| 1538393657 | Zia Ahmed Sial | Family Medicine | 7880 Lincole Pl, Lisbon, OH 44432-8322 | 2009-05-04 |
| 1043490790 | Innovis Health, LLC. | Family Medicine | 819 Main St, Lisbon, ND 58054-4244 | 2007-11-10 |
| 1386831253 | Frank D Lazzerini | Family Medicine | 7880 Lincole Pl, Community Action Agency, Lisbon, OH 44432-8322 | 2007-09-25 |
| 1699969469 | Bert Coppotelli Md LLC | Family Medicine | 2 Lee Rd, Lisbon, CT 06351-3015 | 2007-09-05 |
| Find all providers in LISBON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.