Provider Demographics
NPI:1356947063
Name:COOPER, ELISABETH BRENDA
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:BRENDA
Last Name:COOPER
Suffix:
Gender:F
Credentials:
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9199 REISTERSTOWN RD STE 101B
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4513
Mailing Address - Country:US
Mailing Address - Phone:443-898-8160
Mailing Address - Fax:443-898-8916
Practice Address - Street 1:9199 REISTERSTOWN RD STE 101B
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4513
Practice Address - Country:US
Practice Address - Phone:443-898-8160
Practice Address - Fax:443-898-8916
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant