Provider Demographics
NPI:1164684577
Name:COPELAND, MARILYN ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:ELIZABETH
Last Name:COPELAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:ELIZABETH
Other - Last Name:GIOLMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:520 BLOSSOM ST
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4210
Mailing Address - Country:US
Mailing Address - Phone:281-332-9537
Mailing Address - Fax:281-332-1560
Practice Address - Street 1:520 BLOSSOM ST
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4210
Practice Address - Country:US
Practice Address - Phone:281-332-9537
Practice Address - Fax:281-332-1560
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008016700207X00000X
TXQ0621207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX348546801Medicaid
TX391997YN9CMedicare PIN