Provider Demographics
NPI:1942427570
Name:COOPER, SAMUEL EUGENE (LPN)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:EUGENE
Last Name:COOPER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 JAMESTOWN CT
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-2206
Mailing Address - Country:US
Mailing Address - Phone:410-679-0585
Mailing Address - Fax:410-679-0385
Practice Address - Street 1:571 JAMESTOWN CT
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-2206
Practice Address - Country:US
Practice Address - Phone:410-679-0585
Practice Address - Fax:410-679-0385
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP31131251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care