MEDICARE: MICHAEL T COOPERMAN MD

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	207R00000X	Internal Medicine Physician	MD017737E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	37280	OTHER	AETNA
3	00544020001	OTHER	KEYSTONE HPE
4	8864099004	OTHER	CIGNA
5	1025978	OTHER	KEYSTONE MERCY

General Provider Information

NPI Number	:	1972568244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL T COOPERMAN MD

Provider Business Mailing Address
First Line	:	25 WASHINGTON LN
Second Line	:	STE 22C
City	:	WYNCOTE
State	:	PA
Zip	:	19095-1425
Country	:	US
Telephone Number	:	215-635-4902
Fax Number	:	215-635-2565

Provider Business Practice Location Address
First Line	:	921 WEST CHELTENHAM AVE
Second Line	:
City	:	MELROSE PARK
State	:	PA
Zip	:	19027
Country	:	US
Telephone Number	:	215-635-4902
Fax Number	:	215-635-2565

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	07/15/2019

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Directions to “ MICHAEL T COOPERMAN MD” Practice Location

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