Provider Demographics
NPI:1003130683
Name:M D COOPER INC.
Entity Type:Organization
Organization Name:M D COOPER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-626-0225
Mailing Address - Street 1:2819 HAYES AVE
Mailing Address - Street 2:STE. 6
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-5391
Mailing Address - Country:US
Mailing Address - Phone:419-626-0225
Mailing Address - Fax:419-626-0755
Practice Address - Street 1:2819 HAYES AVE
Practice Address - Street 2:STE. 6
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5391
Practice Address - Country:US
Practice Address - Phone:419-626-0225
Practice Address - Fax:419-626-0755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048099C207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0528638Medicaid
OH0528638Medicaid