Provider Demographics
NPI:1952369829
Name:KOPELSON, GENE (MD)
Entity type:Individual
Prefix:
First Name:GENE
Middle Name:
Last Name:KOPELSON
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 1:139 WILDROSE RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-1836
Mailing Address - Country:US
Mailing Address - Phone:800-366-1884
Mailing Address - Fax:
Practice Address - Street 1:675 E 2100 S
Practice Address - Street 2:SUITE 390
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-1887
Practice Address - Country:US
Practice Address - Phone:800-366-1884
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA431002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology