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General NPI Number Information
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NPI Number | 1306831326
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Entity Type | Individual
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Provider Name | MARK W COOPER M.D.,MBA
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Gender | Male
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Dates
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Enumeration Date | 09/15/2005
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Last Update Date | 12/16/2014
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Provider Practice Location Address
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Address Line | 2301 S BROAD ST SUITE 205A
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City | PHILADELPHIA
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State | PA
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Zip | 19148-3542
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Country | US
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Telephone | 215-952-9153
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Fax | 215-952-1255
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Provider Business Mailing Address
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Address Line | 2301 S BROAD ST SUITE 205A
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City | PHILADELPHIA
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State | PA
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Zip | 19148-3542
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Country | US
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Telephone | 215-952-9153
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Fax | 215-952-1255
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 25MA07499200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD021440E
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License Number State | PA
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