Provider Demographics
NPI:1235159898
Name:COOPER, ROBERT MENACHEM (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MENACHEM
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0030377207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD396801400Medicaid
MD146067ZCVYMedicare PIN
MDD74584Medicare UPIN