Provider Demographics
NPI:1003560939
Name:COPELAND, CARTER DONALD (PA-C)
Entity Type:Individual
Prefix:
First Name:CARTER
Middle Name:DONALD
Last Name:COPELAND
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7865 MISSION GORGE RD APT 205
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-3534
Mailing Address - Country:US
Mailing Address - Phone:619-994-4893
Mailing Address - Fax:
Practice Address - Street 1:7625 MESA COLLEGE DR STE 200A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-5343
Practice Address - Country:US
Practice Address - Phone:858-223-2172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical