MEDICARE: AMANDA S. 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	2085R0204X	Vascular & Interventional Radiology Physician	35.090294	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00418673	OTHER	OH	RR MEDICARE

General Provider Information

NPI Number	:	1619049459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA S. COOPER MD

Provider Business Mailing Address
First Line	:	8100 RAVINES EDGE CT STE 100
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-5426
Country	:	US
Telephone Number	:	614-488-5090
Fax Number	:	614-845-5216

Provider Business Practice Location Address
First Line	:	8100 RAVINES EDGE CT STE 100
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-5426
Country	:	US
Telephone Number	:	614-488-5090
Fax Number	:	614-845-5216

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	03/30/2021

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Directions to “ AMANDA S. COOPER MD” Practice Location

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