1528199346 NPI number — BETSY J COOPER M.D.

Table of content: BETSY J COOPER M.D. (NPI 1528199346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528199346 NPI number — BETSY J COOPER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOPER
Provider First Name:
BETSY
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528199346
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4501 CONNECTICUT AVE NW
Provider Second Line Business Mailing Address:
APT. 116
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20008-3710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-685-0005
Provider Business Mailing Address Fax Number:
703-685-0006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
927 S WALTER REED DR
Provider Second Line Business Practice Location Address:
SUITE 12
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22204-2380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-685-0005
Provider Business Practice Location Address Fax Number:
703-685-0006
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  16501 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 01010340515 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7192037 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com