Healthcare Provider Details

I. General information

NPI: 1932662475
Provider Name (Legal Business Name): ANNIKA MARIE KOPPEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3116 N DUKE ST
DURHAM NC
27704-2102
US

IV. Provider business mailing address

3116 N DUKE ST
DURHAM NC
27704-2102
US

V. Phone/Fax

Practice location:
  • Phone: 919-620-5333
  • Fax:
Mailing address:
  • Phone: 919-620-5333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number250417
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: