MEDICARE: MELITA COOPER

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	332B00000X	Durable Medical Equipment & Medical Supplies	417923	MD

General Provider Information

NPI Number	:	1477288991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELITA COOPER

Provider Business Mailing Address
First Line	:	1322 IRON FORGE RD
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747-1717
Country	:	US
Telephone Number	:	202-967-5247
Fax Number	:

Provider Business Practice Location Address
First Line	:	1322 IRON FORGE RD
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747-1717
Country	:	US
Telephone Number	:	202-967-5247
Fax Number	:

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

Provider Enumeration Date	:	07/19/2022
Last Update Date	:	01/15/2026

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Directions to “ MELITA COOPER ” Practice Location

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