Provider Demographics
NPI:1770671943
Name:COPELAND, CHRISTOPHER M (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:M
Last Name:COPELAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 W LANE AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-3538
Mailing Address - Country:US
Mailing Address - Phone:614-457-4827
Mailing Address - Fax:614-457-4832
Practice Address - Street 1:1315 W LANE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3538
Practice Address - Country:US
Practice Address - Phone:614-457-4827
Practice Address - Fax:614-457-4832
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047257174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000376723OtherANTHEM
OH20130820028OtherCARESOURCE
OHDE1422OtherRR MEDICARE GROUP NUMBER
OH16001157OtherRAILROAD MEDICARE PROVIDER NUMBER
OH2586296OtherMEDICAID GROUP NUMBER
OHDE1422OtherRR MEDICARE GROUP NUMBER
OH16001157OtherRAILROAD MEDICARE PROVIDER NUMBER