Healthcare Provider Details

I. General information

NPI: 1538256144
Provider Name (Legal Business Name): MARC COOPER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 STUART ST MONCRIEF ARMY COMMUNITY HOSPITAL/CREDENTIALS
COLUMBIA SC
29207-5700
US

IV. Provider business mailing address

4500 STUART ST MONCRIEF ARMY COMMUNITY HOSPITAL/CREDENTIALS
COLUMBIA SC
29207-5700
US

V. Phone/Fax

Practice location:
  • Phone: 803-751-2618
  • Fax: 803-751-2689
Mailing address:
  • Phone: 803-751-2618
  • Fax: 803-751-2689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101102711
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0101102711
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: