MEDICARE: CARY COPELAND DPM INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	213ES0103X	Foot & Ankle Surgery Podiatrist
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1184590069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARY COPELAND DPM INC

Provider Business Mailing Address
First Line	:	PO BOX 825159
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19182-5159
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4010 N BEND RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-3500
Country	:	US
Telephone Number	:	513-541-5709
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	ROSALIE KREIGHBAUM
Credential	:
Telephone Number	:	314-909-1920

Provider Enumeration Date	:	10/16/2025
Last Update Date	:	10/16/2025

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