Provider Demographics
NPI:1619918356
Name:COOPER, JENNIFER ZAHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ZAHN
Last Name:COOPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3445 BOX HILL CORPORATE CENTER DR STE E
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-1223
Mailing Address - Country:US
Mailing Address - Phone:410-569-5151
Mailing Address - Fax:410-569-1131
Practice Address - Street 1:3445 BOX HILL CORPORATE CENTER DR STE E
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-1223
Practice Address - Country:US
Practice Address - Phone:410-569-5151
Practice Address - Fax:410-569-1131
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD63794207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD64794901OtherCAREFIRST OF MD
DCS045-0029OtherBLUE SHIELD FEDERAL
MD64794901OtherCAREFIRST OF MD
DCS045-0029OtherBLUE SHIELD FEDERAL