Provider Demographics
NPI:1255413571
Name:CARY COPELAND DPM INC
Entity type:Organization
Organization Name:CARY COPELAND DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-769-4408
Mailing Address - Street 1:PO BOX 825159
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-5159
Mailing Address - Country:US
Mailing Address - Phone:513-474-1906
Mailing Address - Fax:513-474-9272
Practice Address - Street 1:2450 KIPLING AVE
Practice Address - Street 2:MEDICAL BUILDING 1 SUITE 209
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-6600
Practice Address - Country:US
Practice Address - Phone:513-769-4408
Practice Address - Fax:513-769-4578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000250225OtherANTHEM
OH2399006Medicaid
OH9328651Medicare PIN
OH000000250225OtherANTHEM