Provider Demographics
NPI:1891010484
Name:CARY COPELAND DPM INC
Entity Type:Organization
Organization Name:CARY COPELAND DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DPM
Authorized Official - Prefix:
Authorized Official - First Name:CARY
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-769-4408
Mailing Address - Street 1:1000 MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-2404
Mailing Address - Country:US
Mailing Address - Phone:937-492-1211
Mailing Address - Fax:937-492-6557
Practice Address - Street 1:2335 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-8484
Practice Address - Country:US
Practice Address - Phone:937-332-3668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2010013Medicaid