Mark Alan Koponen, M.D.

Primary specialty

Forensic Pathology PhysicianTaxonomy code 207ZF0201X

License

11172 Issued in ND

Practice address

501 N Columbia Rd Stop 9037
Department of Pathology
Grand Forks, ND 58203-2817

Phone

(701) 777-6172

Fax

(701) 777-3108

NPI assigned

Aug 29, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• University of North Dakota

  • Genetics Clinic/Center
  • Grand Forks, ND
  • NPI 1013032663
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259539200000",
    "number": "1336397553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 N COLUMBIA RD STOP 9037",
            "address_2": "DEPARTMENT OF PATHOLOGY",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582032817",
            "telephone_number": "701-777-6172",
            "fax_number": "701-777-3108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 N COLUMBIA RD STOP 9037",
            "address_2": "DEPARTMENT OF PATHOLOGY",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582032817",
            "telephone_number": "701-777-6172",
            "fax_number": "701-777-3108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPONEN",
        "first_name": "MARK",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-29",
        "last_updated": "2009-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZF0201X",
            "taxonomy_group": "",
            "desc": "Pathology, Forensic Pathology",
            "state": "ND",
            "license": "11172",
            "primary": true
        },
        {
            "code": "207ZF0201X",
            "taxonomy_group": "",
            "desc": "Pathology, Forensic Pathology",
            "state": "MN",
            "license": "52274",
            "primary": false
        },
        {
            "code": "207ZF0201X",
            "taxonomy_group": "",
            "desc": "Pathology, Forensic Pathology",
            "state": "NM",
            "license": "88-39",
            "primary": false
        },
        {
            "code": "207ZF0201X",
            "taxonomy_group": "",
            "desc": "Pathology, Forensic Pathology",
            "state": "MT",
            "license": "10086",
            "primary": false
        },
        {
            "code": "207ZF0201X",
            "taxonomy_group": "",
            "desc": "Pathology, Forensic Pathology",
            "state": "GA",
            "license": "34173",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Forensic Pathology Physician in Grand Forks, ND
• Providers in Grand Forks, ND by specialty
• Forensic Pathology Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.