Provider Demographics
NPI:1740277177
Name:COOPER, JOSEPH DAVID (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DAVID
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:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 E 8TH ST STE 150
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-3383
Practice Address - Country:US
Practice Address - Phone:740-376-5590
Practice Address - Fax:740-376-5591
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV15249207W00000X
OH35.055064207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0095523000Medicaid
OH0848337Medicaid
OHP01253887OtherRAILROAD MEDICARE - MHCPI
OHP01253887OtherRAILROAD MEDICARE - MHCPI
OHH137851Medicare PIN
D97885Medicare UPIN