Provider Demographics
NPI:1447443726
Name:COPELAND, FERNANDA D (RD)
Entity type:Individual
Prefix:
First Name:FERNANDA
Middle Name:D
Last Name:COPELAND
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:FERNANDA
Other - Last Name:DOS SANTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPT 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8051
Mailing Address - Fax:
Practice Address - Street 1:291 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-3628
Practice Address - Country:US
Practice Address - Phone:617-629-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2536133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAAAA96834OtherHARVARD PILGRIM
MALD0230OtherBLUE CROSS BLUE SHEILD
MA9750052OtherAETNA
MA0041656OtherNEIGHBORHOOD HEALTH PLAN
MA9750052OtherAETNA