Provider Demographics
NPI:1114247129
Name:ELLIOT W COOPERMAN MD PA
Entity Type:Organization
Organization Name:ELLIOT W COOPERMAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:W
Authorized Official - Last Name:COOPERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-898-6091
Mailing Address - Street 1:311 E EVANS ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4613
Mailing Address - Country:US
Mailing Address - Phone:407-898-6091
Mailing Address - Fax:407-896-3452
Practice Address - Street 1:311 E EVANS ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4613
Practice Address - Country:US
Practice Address - Phone:407-898-6091
Practice Address - Fax:407-896-3452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty