Healthcare Provider Details

I. General information

NPI: 1275022493
Provider Name (Legal Business Name): MEGAN COPELAND MS, CNS, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 SANSBURY RD
FRIENDSHIP MD
20758-9714
US

IV. Provider business mailing address

PO BOX 173
FRIENDSHIP MD
20758-0173
US

V. Phone/Fax

Practice location:
  • Phone: 301-643-7507
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number17319
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberDX4376
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: