Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | MD028546E | PA |
NPI | 1154316651 |
---|---|
Provider Name | Colleen A Cooper |
First Address | Allentown, PA 18105-1754 |
Second Address | Allentown, PA 18104-2258 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 04/08/2010 |