Provider Demographics
NPI:1063908119
Name:COPE, JOHN D
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:COPE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3472 HILLSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16116-3424
Mailing Address - Country:US
Mailing Address - Phone:724-651-4023
Mailing Address - Fax:
Practice Address - Street 1:585 E STATE ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146
Practice Address - Country:US
Practice Address - Phone:724-346-6494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019164363LP0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program