Provider Demographics
NPI:1508843152
Name:COPELAND, NANCY E (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:E
Last Name:COPELAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20400 OBSERVATION DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-4085
Mailing Address - Country:US
Mailing Address - Phone:301-972-9559
Mailing Address - Fax:301-972-9593
Practice Address - Street 1:20400 OBSERVATION DR
Practice Address - Street 2:SUITE 205
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4085
Practice Address - Country:US
Practice Address - Phone:301-972-9559
Practice Address - Fax:301-972-9593
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-26
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0060569174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD001198300Medicaid