Provider Demographics
NPI:1265403968
Name:COOPERSTEIN, ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:COOPERSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:100 15TH ST NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-1616
Mailing Address - Country:US
Mailing Address - Phone:276-439-1840
Mailing Address - Fax:273-439-1845
Practice Address - Street 1:100 15TH ST NW
Practice Address - Street 2:SUITE A
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1616
Practice Address - Country:US
Practice Address - Phone:276-439-1840
Practice Address - Fax:273-439-1845
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101225500207Q00000X
TN30462207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1265403968Medicaid
VA005608872Medicaid
VAVV4349CMedicare PIN
VA005608872Medicaid