Healthcare Provider Details

I. General information

NPI: 1346220548
Provider Name (Legal Business Name): RICHARD COLEMAN COOPER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 AMHERST ST
WINCHESTER VA
22601-2808
US

IV. Provider business mailing address

125 MEDICAL CIR
WINCHESTER VA
22601-3300
US

V. Phone/Fax

Practice location:
  • Phone: 540-450-0072
  • Fax: 540-450-0074
Mailing address:
  • Phone: 540-667-1828
  • Fax: 540-722-3658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number0101042491
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: