Healthcare Provider Details

I. General information

NPI: 1407147044
Provider Name (Legal Business Name): MARCIN KOPEC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MARTIN KOPEC MD

II. Dates (important events)

Enumeration Date: 05/01/2011
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 KINGSLEY LN
NORFOLK VA
23505-4614
US

IV. Provider business mailing address

110 KINGSLEY LN
NORFOLK VA
23505-4614
US

V. Phone/Fax

Practice location:
  • Phone: 757-889-5422
  • Fax: 757-889-5450
Mailing address:
  • Phone: 757-889-5422
  • Fax: 757-889-5450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberE-16430
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA12756000
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101267995
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number68759
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: