Provider Demographics
NPI:1154346369
Name:COOPER, CAROL H (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:H
Last Name:COOPER
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:PO BOX 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:1200 CENTRAL AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7575
Practice Address - Country:US
Practice Address - Phone:606-324-1483
Practice Address - Fax:606-329-2612
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28550174400000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0723902OtherMEDICARE ID
KY64285505Medicaid
KY64285505Medicaid