Provider Demographics
NPI:1548297013
Name:COOPER, EMMETT GEORGE (MD)
Entity type:Individual
Prefix:
First Name:EMMETT
Middle Name:GEORGE
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 1:125 WILLIAM HOWARD TAFT RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2103
Mailing Address - Country:US
Mailing Address - Phone:513-861-9433
Mailing Address - Fax:
Practice Address - Street 1:199 WILLIAM HOWARD TAFT RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2103
Practice Address - Country:US
Practice Address - Phone:513-616-8774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0392002084A0401X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0317446Medicaid
OHCO2387Medicare UPIN