07D0936018 CLIA NUMBER - BERT COPPOTELLI MD LLC

Laboratory Demographics

CLIA Number: 07D0936018

Facility Name: BERT COPPOTELLI MD LLC

Facility Address:
2 LEE ROAD
LISBON, CT
ZIP 06351
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Facility Phone Number: 860 376-4451

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1629070941

Taxonomy: 207Q00000X - 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.

CLIA Record

Field Name	Field Value
CLIA Number	07D0936018
LAB Type	Physician Office
Facility Name	BERT COPPOTELLI MD LLC
Street	2 LEE ROAD
City	LISBON
State	CT
ZIP	06351
Phone	860 376-4451
CertificateType	4
CertificateEffectiveDate	11/13/2023
CertificateExpirationDate	11/12/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024