Provider Demographics
NPI:1881861920
Name:COOPER BARTON, THEA (DO)
Entity Type:Individual
Prefix:DR
First Name:THEA
Middle Name:
Last Name:COOPER BARTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 PENLLYN BLUE BELL PIKE
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-1656
Mailing Address - Country:US
Mailing Address - Phone:215-542-9700
Mailing Address - Fax:215-542-9756
Practice Address - Street 1:790 PENLLYN BLUE BELL PIKE
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1656
Practice Address - Country:US
Practice Address - Phone:215-542-9700
Practice Address - Fax:215-542-9756
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT010661207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology