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General NPI Number Information
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NPI Number | 1477654184
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Entity Type | Individual
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Provider Name | DIREESE MARY COOPER DPM
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Gender | Female
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 12/28/2025
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Provider Practice Location Address
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Address Line | 6400 CLEARVIEW ST
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City | PHILADELPHIA
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State | PA
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Zip | 19119-2040
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Country | US
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Telephone | 215-844-5688
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Fax | 215-844-5689
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Provider Business Mailing Address
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Address Line | 8603 GILBERT STREET
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City | PHILADELPHIA
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State | PA
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Zip | 19150
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Country | US
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Telephone | 215-248-1090
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Fax | 215-248-1090
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | SC0058R
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License Number State | PA
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