Provider Demographics
NPI:1700954120
Name:COOPER, BRUCE S (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:S
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6329 WINDERMERE CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3550
Mailing Address - Country:US
Mailing Address - Phone:301-655-0163
Mailing Address - Fax:
Practice Address - Street 1:6329 WINDERMERE CIR
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-3550
Practice Address - Country:US
Practice Address - Phone:301-655-0163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023863207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
005913M92Medicare ID - Type Unspecified
C89014Medicare UPIN