Provider Demographics
NPI:1982986238
Name:COOPER, COLLIN DALLAS (PA)
Entity Type:Individual
Prefix:MR
First Name:COLLIN
Middle Name:DALLAS
Last Name:COOPER
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Gender:M
Credentials:PA
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Mailing Address - Street 1:919 CONESTOGA RD
Mailing Address - Street 2:BLUILDING #1 SUITE# 300
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1352
Mailing Address - Country:US
Mailing Address - Phone:610-525-6580
Mailing Address - Fax:610-525-3664
Practice Address - Street 1:919 CONESTOGA RD
Practice Address - Street 2:BLUILDING #1 SUITE# 300
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1352
Practice Address - Country:US
Practice Address - Phone:610-525-6580
Practice Address - Fax:610-525-3664
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
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Provider Licenses
StateLicense IDTaxonomies
PAMA054907363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant