Healthcare Provider Details

I. General information

NPI: 1114002565
Provider Name (Legal Business Name): STEPHEN MICHAEL COOPER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 POWER ST
SALISBURY MD
21804-6940
US

IV. Provider business mailing address

PO BOX 1978
SALISBURY MD
21802-1978
US

V. Phone/Fax

Practice location:
  • Phone: 410-749-1022
  • Fax: 410-630-1682
Mailing address:
  • Phone: 410-749-1015
  • Fax: 410-749-0654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0029665
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: