Provider Demographics
NPI:1003161340
Name:COOPER, ANDREW ASTLEY (PHD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:ASTLEY
Last Name:COOPER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11220 BELLFLOWER RD
Mailing Address - Street 2:RM 103
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-3933
Mailing Address - Country:US
Mailing Address - Phone:216-368-6257
Mailing Address - Fax:
Practice Address - Street 1:11220 BELLFLOWER RD
Practice Address - Street 2:RM 103
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-3933
Practice Address - Country:US
Practice Address - Phone:216-368-6257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program