Healthcare Provider Details

I. General information

NPI: 1093886111
Provider Name (Legal Business Name): ALISON H KOPELMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2006
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 MAIN ST
SACO ME
04072-1543
US

IV. Provider business mailing address

1 MEDICAL CENTER DR
BIDDEFORD ME
04005-9422
US

V. Phone/Fax

Practice location:
  • Phone: 207-294-5959
  • Fax: 207-284-6291
Mailing address:
  • Phone: 207-282-9080
  • Fax: 207-284-6271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD17581
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: