Healthcare Provider Details

I. General information

NPI: 1932193174
Provider Name (Legal Business Name): MARC COOPERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 DEER CRK E
POWELL OH
43065-9750
US

IV. Provider business mailing address

250 DEER CRK E
POWELL OH
43065-9750
US

V. Phone/Fax

Practice location:
  • Phone: 614-888-4497
  • Fax:
Mailing address:
  • Phone: 614-888-4497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35040678
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: