Provider Demographics
NPI:1164484341
Name:COOPER, BYRON S (MD)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:S
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 M ST NW
Mailing Address - Street 2:810
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1404
Mailing Address - Country:US
Mailing Address - Phone:202-833-3000
Mailing Address - Fax:202-835-9040
Practice Address - Street 1:2440 M ST NW
Practice Address - Street 2:810
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1404
Practice Address - Country:US
Practice Address - Phone:202-833-3000
Practice Address - Fax:202-835-9040
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2011-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD12803207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC026707600Medicaid
DC110137084OtherRAILROAD MEDICARE
DC026707600Medicaid
DC134160C53Medicare PIN
DC759653Medicare ID - Type Unspecified