Provider Demographics
NPI:1750632063
Name:KOROPECKYJ, MARKO (HAD)
Entity type:Individual
Prefix:
First Name:MARKO
Middle Name:
Last Name:KOROPECKYJ
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 N POINT BLVD
Mailing Address - Street 2:STE. 705
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-3415
Mailing Address - Country:US
Mailing Address - Phone:410-288-7100
Mailing Address - Fax:410-288-7102
Practice Address - Street 1:1005 N POINT BLVD
Practice Address - Street 2:STE. 705
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-3415
Practice Address - Country:US
Practice Address - Phone:410-288-7100
Practice Address - Fax:410-288-7102
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment