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NPI Code Detail

MEDICARE: DEBRA COPELAND SIZEMORE PAC

MEDICARE: DEBRA COPELAND SIZEMORE PAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant000101030NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1970025245OTHERRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
27330736OTHERAETNA
394719OTHERMEDCOST

General Provider Information

NPI Number : 1063497196
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBRA COPELAND SIZEMORE PAC
Provider Business Mailing Address
First Line : PO BOX 344
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27102-0344
Country : US
Telephone Number : 336-716-2255
Fax Number : 336-716-9258
Provider Business Practice Location Address
First Line : 4618 COUNTRY CLUB RD
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27104-3520
Country : US
Telephone Number : 336-716-2255
Fax Number : 336-716-9258
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2005
Last Update Date : 10/21/2010

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Directions to “ DEBRA COPELAND SIZEMORE PAC” Practice Location

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