Healthcare Provider Details

I. General information

NPI: 1902034259
Provider Name (Legal Business Name): DR. KAMDEN KOPANI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST BOX 450
BOSTON MA
02111-1552
US

IV. Provider business mailing address

800 WASHINGTON ST BOX 450
BOSTON MA
02111-1552
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-0626
  • Fax: 617-636-4866
Mailing address:
  • Phone: 617-636-0626
  • Fax: 617-636-4866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number254753
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: