Provider Demographics
NPI:1740288968
Name:COOPER, LEAH MARIE (MD)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:COOPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 E HAMPDEN AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2620
Mailing Address - Country:US
Mailing Address - Phone:303-789-2251
Mailing Address - Fax:303-789-2505
Practice Address - Street 1:221 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2620
Practice Address - Country:US
Practice Address - Phone:303-789-2251
Practice Address - Fax:303-789-2505
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33680207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01336809Medicaid
COC345328Medicare PIN
CO01336809Medicaid