Provider Demographics
NPI:1780695684
Name:COOLEY, OLEG (PA-C)
Entity type:Individual
Prefix:MR
First Name:OLEG
Middle Name:
Last Name:COOLEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 E CHURCH ST STE 2100
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-2271
Mailing Address - Country:US
Mailing Address - Phone:814-443-1281
Mailing Address - Fax:814-443-3214
Practice Address - Street 1:126 E CHURCH ST STE 2100
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2271
Practice Address - Country:US
Practice Address - Phone:814-443-1281
Practice Address - Fax:814-443-3214
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001256L363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001452375OtherBLUE SHIELD PROVIDER #