Provider Demographics
NPI:1316936339
Name:COPELAND, TERESE AGNES (MD)
Entity type:Individual
Prefix:DR
First Name:TERESE
Middle Name:AGNES
Last Name:COPELAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 MAPLE AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-5555
Mailing Address - Country:US
Mailing Address - Phone:518-581-0999
Mailing Address - Fax:518-581-7098
Practice Address - Street 1:414 MAPLE AVE STE 600
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866
Practice Address - Country:US
Practice Address - Phone:518-581-0999
Practice Address - Fax:518-581-7098
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206064207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01760076Medicaid
NY56675BMedicare ID - Type Unspecified
NY01760076Medicaid