MEDICARE: MR. ORRIN ANTON 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	172A00000X	Driver	23533443	PA

General Provider Information

NPI Number	:	1861686453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ORRIN ANTON COOPER

Provider Business Mailing Address
First Line	:	7505 ELMWOOD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19153-1312
Country	:	US
Telephone Number	:	215-365-7414
Fax Number	:	215-365-7414

Provider Business Practice Location Address
First Line	:	7505 ELMWOOD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19153-1312
Country	:	US
Telephone Number	:	215-365-7414
Fax Number	:	215-365-7414

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

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	08/28/2007

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