Provider Demographics
NPI:1497781587
Name:COOLER, STEWART (MD)
Entity Type:Individual
Prefix:DR
First Name:STEWART
Middle Name:
Last Name:COOLER
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 1:1331EAST WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-3808
Mailing Address - Country:US
Mailing Address - Phone:215-743-3784
Mailing Address - Fax:215-743-3781
Practice Address - Street 1:1331EAST WYOMING AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-3808
Practice Address - Country:US
Practice Address - Phone:215-743-3784
Practice Address - Fax:215-743-3781
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036325L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03512OtherHEALTH PARTNERS
PA1043624OtherKEYSTONE MERCY HEALTH PLA
PA0047040OtherAETNA
PA025627OtherIBC
PA6136616OtherCIGNA
PA0061121201OtherAMERICHOICE OF PA
PA0006112120002Medicaid
PA03512OtherHEALTH PARTNERS