Provider Demographics
NPI:1346220548
Name:COOPER, RICHARD COLEMAN (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:COLEMAN
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 1:125 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3300
Mailing Address - Country:US
Mailing Address - Phone:540-667-1828
Mailing Address - Fax:540-722-3658
Practice Address - Street 1:1818 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2808
Practice Address - Country:US
Practice Address - Phone:540-450-0072
Practice Address - Fax:540-450-0074
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042491207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA386737OtherANTHEM
WV0088764000OtherMEDICAID
VAC36645Medicare UPIN