Provider Demographics
NPI:1659519783
Name:COPELAND, MONA (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:MONA
Middle Name:
Last Name:COPELAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6111 AVALON GATES
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-5818
Mailing Address - Country:US
Mailing Address - Phone:860-978-2296
Mailing Address - Fax:
Practice Address - Street 1:6111 AVALON GATES
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-5818
Practice Address - Country:US
Practice Address - Phone:860-978-2296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CT363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant