Provider Demographics
NPI:1427268028
Name:KAREN COOPER MD
Entity type:Organization
Organization Name:KAREN COOPER MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-288-4595
Mailing Address - Street 1:920 WYOMING AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FORTY FORT
Mailing Address - State:PA
Mailing Address - Zip Code:18704
Mailing Address - Country:US
Mailing Address - Phone:570-288-4595
Mailing Address - Fax:570-288-4601
Practice Address - Street 1:920 WYOMING AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:FORTY FORT
Practice Address - State:PA
Practice Address - Zip Code:18704-3953
Practice Address - Country:US
Practice Address - Phone:570-288-4595
Practice Address - Fax:570-288-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043628E207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1750795OtherPENNSYLVANIA BLUE SHIELD
OR1750795OtherPENNSYLVANIA BLUE SHIELD
PA421101Medicare ID - Type Unspecified