Provider Demographics
NPI:1467161513
Name:COOPER, ROBERT WESTLEY
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WESTLEY
Last Name:COOPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3998 NORTHGATE PL
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2564
Mailing Address - Country:US
Mailing Address - Phone:301-923-5688
Mailing Address - Fax:
Practice Address - Street 1:3998 NORTHGATE PL
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2564
Practice Address - Country:US
Practice Address - Phone:301-923-5688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health