Provider Demographics
NPI:1457315863
Name:COOPER, RONALD HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:HOWARD
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10008 PRESTWICH TER
Mailing Address - Street 2:
Mailing Address - City:IJAMSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21754-9601
Mailing Address - Country:US
Mailing Address - Phone:301-865-6291
Mailing Address - Fax:301-865-0860
Practice Address - Street 1:10008 PRESTWICH TER
Practice Address - Street 2:
Practice Address - City:IJAMSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21754-9601
Practice Address - Country:US
Practice Address - Phone:301-865-6291
Practice Address - Fax:301-865-0860
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052484207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2427390OtherUNITED HEALTH CARE
MD4571101OtherCARE FIRST
MD493906OtherNCPPO
MD11084846OtherMULTI-PLAN
DC14590004OtherBLUE SHIELD
MD6143836OtherCIGNA
MD2427390OtherUNITED HEALTH CARE