Healthcare Provider Details

I. General information

NPI: 1588699375
Provider Name (Legal Business Name): BRAD J COOPER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 WATER ST
THURMONT MD
21788-1912
US

IV. Provider business mailing address

3421 CONCORD RD SUITE B3
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 301-271-3535
  • Fax: 301-271-2650
Mailing address:
  • Phone: 717-851-1405
  • Fax: 301-271-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD050724L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0022819
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: