Healthcare Provider Details

I. General information

NPI: 1912926825
Provider Name (Legal Business Name): MARCIA A. COPELAND M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 10/16/2009
Certification Date:
Deactivation Date: 07/17/2007
Reactivation Date: 12/26/2007

III. Provider practice location address

29 E 29TH ST
BAYONNE NJ
07002-4654
US

IV. Provider business mailing address

10 COMMERCE DR
NEW ROCHELLE NY
10801-5214
US

V. Phone/Fax

Practice location:
  • Phone: 201-858-5000
  • Fax:
Mailing address:
  • Phone: 914-637-3510
  • Fax: 914-819-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA06442700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: