MEDICARE: DM COOPER DPM AND ASSOC PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1013182369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DM COOPER DPM AND ASSOC PC

Provider Business Mailing Address
First Line	:	8603 GILBERT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-2703
Country	:	US
Telephone Number	:	215-844-5688
Fax Number	:	215-248-1090

Provider Business Practice Location Address
First Line	:	6400 CLEARVIEW ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-2040
Country	:	US
Telephone Number	:	215-844-5688
Fax Number	:

Authorized Official
Title or Position	:	PODIATRIST
Name	:	DR. DIREESE MARY COOPER
Credential	:	DPM
Telephone Number	:	215-844-5688

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	04/30/2008

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