Provider Demographics
NPI:1770800955
Name:DM COOPER, DPM & ASSOCIATES, DPM
Entity type:Organization
Organization Name:DM COOPER, DPM & ASSOCIATES, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DIREESE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:267-972-9992
Mailing Address - Street 1:8603 GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-2703
Mailing Address - Country:US
Mailing Address - Phone:267-972-9992
Mailing Address - Fax:267-385-5022
Practice Address - Street 1:2621 W 9TH ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-2115
Practice Address - Country:US
Practice Address - Phone:267-972-9992
Practice Address - Fax:267-385-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003585R213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001232500000Medicaid
PAU16811Medicare UPIN
659296Medicare PIN