Provider Demographics
NPI:1831486182
Name:COOPER, JULIE THERESE (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:THERESE
Last Name:COOPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:THERESE
Other - Last Name:ABRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1300 THORNTON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4654
Mailing Address - Country:US
Mailing Address - Phone:540-371-6810
Mailing Address - Fax:
Practice Address - Street 1:1300 THORNTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4654
Practice Address - Country:US
Practice Address - Phone:540-371-6810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101259858207K00000X
OH35.123231208000000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics