Provider Demographics
NPI:1861686453
Name:COOPER, ORRIN ANTON
Entity type:Individual
Prefix:MR
First Name:ORRIN
Middle Name:ANTON
Last Name:COOPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19153-1312
Mailing Address - Country:US
Mailing Address - Phone:215-365-7414
Mailing Address - Fax:215-365-7414
Practice Address - Street 1:7505 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19153-1312
Practice Address - Country:US
Practice Address - Phone:215-365-7414
Practice Address - Fax:215-365-7414
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA23533443172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver