MEDICARE: MICHELLE COPELAND DMD MD PC

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
1	208200000X	Plastic Surgery Physician	147955-1	NY

General Provider Information

NPI Number	:	1538461629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHELLE COPELAND DMD MD PC

Provider Business Mailing Address
First Line	:	1001 5TH AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10028-0107
Country	:	US
Telephone Number	:	212-452-2200
Fax Number	:	212-452-2208

Provider Business Practice Location Address
First Line	:	1001 5TH AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10028-0107
Country	:	US
Telephone Number	:	212-452-2200
Fax Number	:	212-452-2208

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHELLE COPELAND
Credential	:	D.M.D., M.D.
Telephone Number	:	212-452-2200

Provider Enumeration Date	:	11/23/2010
Last Update Date	:	07/20/2023

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