Healthcare Provider Details

I. General information

NPI: 1134065691
Provider Name (Legal Business Name): MARCIA COOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12501 PROSPERITY DR STE 100
SILVER SPRING MD
20904-1647
US

IV. Provider business mailing address

8110 MISSISSIPPI RD
LAUREL MD
20724-6123
US

V. Phone/Fax

Practice location:
  • Phone: 301-681-6730
  • Fax: 301-681-4268
Mailing address:
  • Phone: 240-601-0121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberR166094
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: