Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | MD044113L | PA |
NPI | 1386018844 |
---|---|
Provider Name | Dr. Brenda Cooperstone |
First Address | Bryn Mawr, PA 19010-1261 |
Second Address | Bryn Mawr, PA 19010-1261 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2015 |
Last Update Date | 20/11/2015 |