Healthcare Provider Details

I. General information

NPI: 1376672832
Provider Name (Legal Business Name): SPENCER THOMAS COPLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 GOLF HOUSE CT E LEBAUER HEALTHCARE AT STONEY CREEK
WHITSETT NC
27377-9296
US

IV. Provider business mailing address

1200 N ELM ST
GREENSBORO NC
27401-1004
US

V. Phone/Fax

Practice location:
  • Phone: 336-449-9848
  • Fax: 336-449-9749
Mailing address:
  • Phone: 336-832-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2007-01233
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: