Provider Demographics
NPI:1013182369
Name:DM COOPER DPM AND ASSOC PC
Entity Type:Organization
Organization Name:DM COOPER DPM AND ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DIREESE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-844-5688
Mailing Address - Street 1:8603 GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-2703
Mailing Address - Country:US
Mailing Address - Phone:215-844-5688
Mailing Address - Fax:215-248-1090
Practice Address - Street 1:6400 CLEARVIEW ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2040
Practice Address - Country:US
Practice Address - Phone:215-844-5688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0645800001Medicare NSC
PA0645800002Medicare NSC