Provider Demographics
NPI:1932159480
Name:COOPER, DAVID S (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
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 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-2704
Mailing Address - Fax:
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:SUITE 333
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-502-4926
Practice Address - Fax:410-502-8172
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD32175207R00000X, 2085R0202X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCB9283OtherR/R MEDICARE GROUP #
MD110115209OtherR/R MEDICARE PROVIDER #
MD378111900Medicaid
MDS578G224Medicare PIN
MD110115209OtherR/R MEDICARE PROVIDER #
MDE13658Medicare UPIN
MD378111900Medicaid