Provider Demographics
NPI:1336397553
Name:KOPONEN, MARK ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:KOPONEN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:501 N COLUMBIA RD STOP 9037
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-2817
Mailing Address - Country:US
Mailing Address - Phone:701-777-6172
Mailing Address - Fax:701-777-3108
Practice Address - Street 1:501 N COLUMBIA RD STOP 9037
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203-2817
Practice Address - Country:US
Practice Address - Phone:701-777-6172
Practice Address - Fax:701-777-3108
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2009-11-30
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Provider Licenses
StateLicense IDTaxonomies
ND11172207ZF0201X
MN52274207ZF0201X
NM88-39207ZF0201X
MT10086207ZF0201X
GA34173207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology