Provider Demographics
NPI:1528199346
Name:COOPER, BETSY J (MD)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:J
Last Name:COOPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4501 CONNECTICUT AVE NW
Mailing Address - Street 2:APT. 116
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-3710
Mailing Address - Country:US
Mailing Address - Phone:703-685-0005
Mailing Address - Fax:703-685-0006
Practice Address - Street 1:927 S WALTER REED DR
Practice Address - Street 2:SUITE 12
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-2380
Practice Address - Country:US
Practice Address - Phone:703-685-0005
Practice Address - Fax:703-685-0006
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DC165012084P0800X
VA010103405152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7192037Medicaid
VAC88064Medicare UPIN
VA7192037Medicaid