Provider Demographics
NPI:1154572147
Name:JEFFREY COOPER, MD, PC
Entity type:Organization
Organization Name:JEFFREY COOPER, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-659-8805
Mailing Address - Street 1:723 FITZWATERTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1332
Mailing Address - Country:US
Mailing Address - Phone:215-659-8805
Mailing Address - Fax:215-784-9729
Practice Address - Street 1:723 FITZWATERTOWN ROAD
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1332
Practice Address - Country:US
Practice Address - Phone:215-659-8805
Practice Address - Fax:215-784-9729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016420E207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC27870Medicare UPIN