Healthcare Provider Details

I. General information

NPI: 1477288991
Provider Name (Legal Business Name): MELITA COOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 IRON FORGE RD
DISTRICT HEIGHTS MD
20747-1717
US

IV. Provider business mailing address

1322 IRON FORGE RD
DISTRICT HEIGHTS MD
20747-1717
US

V. Phone/Fax

Practice location:
  • Phone: 202-967-5247
  • Fax:
Mailing address:
  • Phone: 202-967-5247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number417923
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: