Provider Demographics
NPI:1215934922
Name:COPELAND, JAY STUART (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:STUART
Last Name:COPELAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9135 PISCATAWAY RD
Mailing Address - Street 2:STE 330
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2549
Mailing Address - Country:US
Mailing Address - Phone:301-856-3233
Mailing Address - Fax:301-856-8573
Practice Address - Street 1:9135 PISCATAWAY RD
Practice Address - Street 2:STE 330
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2549
Practice Address - Country:US
Practice Address - Phone:301-856-3233
Practice Address - Fax:301-856-8573
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD13081208800000X
MDD0008592208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
020662-7OtherBS/VA
DC0444600-3Medicaid
23678OtherAFFORDABLE
99210001OtherBS/NCA
4652389OtherCIGNA
82647/4091451OtherAETNA
26037OtherMD-IPA
412242-03OtherBS/MD
82647/4091451OtherAETNA
C61767Medicare UPIN