Provider Demographics
NPI:1720631781
Name:COOPER, DAVID GREGORY SR
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:GREGORY
Last Name:COOPER
Suffix:SR
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 1:105 GLADES ST
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-8081
Mailing Address - Country:US
Mailing Address - Phone:614-226-9607
Mailing Address - Fax:
Practice Address - Street 1:899 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2341
Practice Address - Country:US
Practice Address - Phone:614-226-9607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator