Provider Demographics
NPI:1275983629
Name:COOPER, JAMES R (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:47149 BUSE RD
Mailing Address - Street 2:
Mailing Address - City:PATUXENT RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:20670-1540
Mailing Address - Country:US
Mailing Address - Phone:301-744-4801
Mailing Address - Fax:
Practice Address - Street 1:4141 W WILSON RD BLDG 1600
Practice Address - Street 2:
Practice Address - City:INDIAN HEAD
Practice Address - State:MD
Practice Address - Zip Code:20640-5162
Practice Address - Country:US
Practice Address - Phone:017-444-8013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012633272083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVAD0000Medicare UPIN