Provider Demographics
NPI:1255332920
Name:COPELAND, JOSEPH CONRAD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CONRAD
Last Name:COPELAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1210 MEDICAL ARTS BLVD
Mailing Address - Street 2:SUITE #315
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46011-3461
Mailing Address - Country:US
Mailing Address - Phone:765-298-4020
Mailing Address - Fax:765-298-4930
Practice Address - Street 1:1210 MEDICAL ARTS BLVD
Practice Address - Street 2:#315
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3461
Practice Address - Country:US
Practice Address - Phone:765-298-4020
Practice Address - Fax:765-298-4930
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2008-05-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01026771A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100170620AMedicaid
INP00095568OtherRETIRED RAILROAD MEDICARE
IN000000079993OtherBLUE CROSS/BLUE SHIELD
IN000000079993OtherBLUE CROSS/BLUE SHIELD
IN100170620AMedicaid