Provider Demographics
NPI:1477535763
Name:COPEN, WILLIAM ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ALAN
Last Name:COPEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 S FEDERAL HWY # 128
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1257
Mailing Address - Country:US
Mailing Address - Phone:617-877-6278
Mailing Address - Fax:
Practice Address - Street 1:300 E 75TH ST APT 8B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3320
Practice Address - Country:US
Practice Address - Phone:617-877-6278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2117292085R0202X
NY2406802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2101386Medicaid
MA468098OtherTUFTS HEALTH PLAN
MAJ28611OtherBCBS MA
MA468098OtherTUFTS HEALTH PLAN
MAJ28611OtherBCBS MA