Provider Demographics
NPI:1457517435
Name:COOPER, HOWARD B (DO)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:B
Last Name:COOPER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:422 HIALEAH DR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-2038
Mailing Address - Country:US
Mailing Address - Phone:856-667-8434
Mailing Address - Fax:856-667-8511
Practice Address - Street 1:422 HIALEAH DR
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2038
Practice Address - Country:US
Practice Address - Phone:856-667-8434
Practice Address - Fax:856-667-8511
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOSOO1803L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D72389Medicare UPIN