Provider Demographics
NPI:1215322243
Name:COOPER, RYAN J (MD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:J
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2027 LEBANON CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:WEST MIFFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15122-2461
Mailing Address - Country:US
Mailing Address - Phone:412-655-8650
Mailing Address - Fax:412-655-6409
Practice Address - Street 1:2027 LEBANON CHURCH RD
Practice Address - Street 2:
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15122-2461
Practice Address - Country:US
Practice Address - Phone:412-655-8650
Practice Address - Fax:412-655-6409
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD465528207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPENDINGMedicaid
PA14327863OtherCAQH