MEDICARE: GENE KOPELSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	43100	MA

General Provider Information

NPI Number	:	1952369829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENE KOPELSON M.D.

Provider Business Mailing Address
First Line	:	139 WILDROSE RD
Second Line	:
City	:	ORANGE
State	:	CT
Zip	:	06477-1836
Country	:	US
Telephone Number	:	800-366-1884
Fax Number	:

Provider Business Practice Location Address
First Line	:	675 E 2100 S
Second Line	:	SUITE 390
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-1887
Country	:	US
Telephone Number	:	800-366-1884
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	07/08/2007

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