Provider Demographics
NPI:1538408570
Name:COOPER, JOHN LAWRENCE
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:LAWRENCE
Last Name:COOPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JACK
Other - Middle Name:
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:100 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4017
Mailing Address - Country:US
Mailing Address - Phone:410-535-8359
Mailing Address - Fax:410-397-5826
Practice Address - Street 1:110 HOSPITAL RD STE 210
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4040
Practice Address - Country:US
Practice Address - Phone:410-535-8359
Practice Address - Fax:410-397-5826
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD92347208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology