Provider Demographics
NPI:1225085426
Name:ROBERT M. COOPER, M.D,, LLC
Entity Type:Organization
Organization Name:ROBERT M. COOPER, M.D,, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-358-2397
Mailing Address - Street 1:6503 PARK HEIGHTS AVE
Mailing Address - Street 2:L-2
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3002
Mailing Address - Country:US
Mailing Address - Phone:410-358-2397
Mailing Address - Fax:410-358-2399
Practice Address - Street 1:6503 PARK HEIGHTS AVE
Practice Address - Street 2:L-2
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-3002
Practice Address - Country:US
Practice Address - Phone:410-358-2397
Practice Address - Fax:410-358-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD396801400Medicaid
MD424093600Medicaid
MD396801400Medicaid
MD146067ZCVYMedicare PIN
MDD74584Medicare UPIN