Provider Demographics
NPI:1144115262
Name:LACOPPOLA, OLIVIA JANE
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:JANE
Last Name:LACOPPOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BECK PL
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1319
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:435 UNION AVE
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-2814
Practice Address - Country:US
Practice Address - Phone:877-345-5300
Practice Address - Fax:561-989-3665
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-10
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant