Provider Demographics
NPI:1457018335
Name:COOPER, MATTHEW R
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:R
Last Name:COOPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STARK COUNTY TASC, INC.
Mailing Address - Street 2:624 MARKET AVE NORTH
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44702
Mailing Address - Country:US
Mailing Address - Phone:330-479-1912
Mailing Address - Fax:
Practice Address - Street 1:STARK COUNTY TASC, INC.
Practice Address - Street 2:624 MARKET AVE NORTH
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702
Practice Address - Country:US
Practice Address - Phone:330-479-1912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist