MEDICARE: COLLEEN A COOPER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	MD028546E	PA

General Provider Information

NPI Number	:	1154316651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN A COOPER MD

Provider Business Mailing Address
First Line	:	PO BOX 1754
Second Line	:
City	:	ALLENTOWN
State	:	PA
Zip	:	18105-1754
Country	:	US
Telephone Number	:	610-798-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1611 POND RD
Second Line	:	SUITE 400
City	:	ALLENTOWN
State	:	PA
Zip	:	18104-2258
Country	:	US
Telephone Number	:	610-395-4300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	08/04/2010

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Directions to “ COLLEEN A COOPER MD” Practice Location

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