Healthcare Provider Details

I. General information

NPI: 1477595510
Provider Name (Legal Business Name): LARRY J COPELAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 RIDGE MILL DR
HILLIARD OH
43026-7752
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-3873
  • Fax: 614-293-3078
Mailing address:
  • Phone: 614-293-3873
  • Fax: 614-293-3078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number35056253
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: