Provider Demographics
NPI:1447562343
Name:COOPER, TYRONE DAVID (EMT-B)
Entity Type:Individual
Prefix:MR
First Name:TYRONE
Middle Name:DAVID
Last Name:COOPER
Suffix:
Gender:M
Credentials:EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 FOXFIELD CIR
Mailing Address - Street 2:APT B
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-2166
Mailing Address - Country:US
Mailing Address - Phone:410-845-8305
Mailing Address - Fax:
Practice Address - Street 1:132 FOXFIELD CIR
Practice Address - Street 2:APT B
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-2166
Practice Address - Country:US
Practice Address - Phone:410-845-8305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10-0056343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)