Provider Demographics
NPI:1609084094
Name:COPELAN, RUSSELL ISAAC (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:ISAAC
Last Name:COPELAN
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 1:1024 RED BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-3848
Mailing Address - Country:US
Mailing Address - Phone:719-432-9322
Mailing Address - Fax:719-365-5184
Practice Address - Street 1:1400 E. BOULDER ST.
Practice Address - Street 2:MEMORIAL HOSPITAL NORTH
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909
Practice Address - Country:US
Practice Address - Phone:719-365-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO244532084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry