Provider Demographics
NPI:1164402780
Name:COPELAND, DIA TAMARA (MD)
Entity Type:Individual
Prefix:
First Name:DIA
Middle Name:TAMARA
Last Name:COPELAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIA
Other - Middle Name:TAMARA
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5807 MAGNOLIA LN
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-1662
Mailing Address - Country:US
Mailing Address - Phone:202-853-0784
Mailing Address - Fax:
Practice Address - Street 1:700 2ND ST NE FL 6
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-8108
Practice Address - Country:US
Practice Address - Phone:202-346-3475
Practice Address - Fax:202-346-3476
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD039957207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN073463200Medicaid
MNP00038088Medicare ID - Type UnspecifiedRAILROAD
MN100000556Medicare ID - Type Unspecified
MN073463200Medicaid