MEDICARE: KAREN 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	207RX0202X	Medical Oncology Physician	MD043628E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1750795	OTHER	OR	PENNSYLVANIA BLUE SHIELD

General Provider Information

NPI Number	:	1427268028
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAREN COOPER MD

Provider Business Mailing Address
First Line	:	920 WYOMING AVE
Second Line	:	SUITE 204
City	:	FORTY FORT
State	:	PA
Zip	:	18704
Country	:	US
Telephone Number	:	570-288-4595
Fax Number	:	570-288-4601

Provider Business Practice Location Address
First Line	:	920 WYOMING AVE
Second Line	:	SUITE 204
City	:	FORTY FORT
State	:	PA
Zip	:	18704-3953
Country	:	US
Telephone Number	:	570-288-4595
Fax Number	:	570-288-4601

Authorized Official
Title or Position	:	REIMBURSEMENT
Name	:	JEAN R SIEGEL
Credential	:
Telephone Number	:	570-288-4595

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	08/22/2020

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