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NPI Code Detail

MEDICARE: DR. MARK W COOPER M.D.,MBA

MEDICARE: DR. MARK W COOPER M.D.,MBA
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
12085R0202XDiagnostic Radiology Physician25MA07499200NJ
22085R0202XDiagnostic Radiology PhysicianMD021440EPA

General Provider Information

NPI Number : 1306831326
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK W COOPER M.D.,MBA
Provider Business Mailing Address
First Line : 2301 S BROAD ST
Second Line : SUITE 205A
City : PHILADELPHIA
State : PA
Zip : 19148-3542
Country : US
Telephone Number : 215-952-9153
Fax Number : 215-952-1255
Provider Business Practice Location Address
First Line : 2301 S BROAD ST
Second Line : SUITE 205A
City : PHILADELPHIA
State : PA
Zip : 19148-3542
Country : US
Telephone Number : 215-952-9153
Fax Number : 215-952-1255
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2005
Last Update Date : 12/16/2014

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