Healthcare Provider Details

I. General information

NPI: 1164402780
Provider Name (Legal Business Name): DIA TAMARA COPELAND M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIA TAMARA SIMMONS M.D.

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 06/06/2021
Certification Date: 06/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 2ND ST NE FL 6
WASHINGTON DC
20002-8108
US

IV. Provider business mailing address

5807 MAGNOLIA LN
FALLS CHURCH VA
22041-1662
US

V. Phone/Fax

Practice location:
  • Phone: 202-346-3475
  • Fax: 202-346-3476
Mailing address:
  • Phone: 202-853-0784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD039957
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: