Provider Demographics
NPI:1376662122
Name:JOSEPH COOPER M.D. INC.
Entity Type:Organization
Organization Name:JOSEPH COOPER M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSIIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-374-4902
Mailing Address - Street 1:400 MATTHEW ST STE 100
Mailing Address - Street 2:MARIETTA MEMORIAL HOSPITAL
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-1656
Mailing Address - Country:US
Mailing Address - Phone:740-374-4902
Mailing Address - Fax:740-374-4941
Practice Address - Street 1:400 MATTHEW ST STE 100
Practice Address - Street 2:MARIETTA MEMORIAL HOSPITAL
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1656
Practice Address - Country:US
Practice Address - Phone:740-374-4902
Practice Address - Fax:740-374-4941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0095523000Medicaid
OH0848337Medicaid
WV0095523000Medicaid
OH0848337Medicaid