Provider Demographics
NPI:1760736375
Name:COSPER, MARCUS STANTON (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:STANTON
Last Name:COSPER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 BURNING TREE LN
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1701
Mailing Address - Country:US
Mailing Address - Phone:330-507-2988
Mailing Address - Fax:
Practice Address - Street 1:4867 URBANA RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-9815
Practice Address - Country:US
Practice Address - Phone:937-323-0951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003499282N00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No282N00000XHospitalsGeneral Acute Care Hospital