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General NPI Number Information
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NPI Number | 1093535031
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Entity Type | Individual
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Provider Name | MRS. KEIARA COOPER
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Gender | Female
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 801 N BROADWAY
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City | BALTIMORE
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State | MD
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Zip | 21205-1424
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Country | US
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Telephone | 443-923-9468
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Fax |
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Provider Business Mailing Address
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Address Line | 21 TEMONS CT
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City | WINDSOR MILL
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State | MD
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Zip | 21244-1465
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Country | US
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Telephone | 443-965-0329
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P0004X
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Taxonomy Name | Spinal Cord Injury Medicine Physician
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License Number | A5969
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License Number State | MD
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