Basic Information
| Provider Information | |||||||||
| NPI: | 1588699375 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOPER | ||||||||
| FirstName: | BRAD | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3421 CONCORD RD | ||||||||
| Address2: | SUITE B3 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174029001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178511405 | ||||||||
| FaxNumber: | 3012712650 | ||||||||
| Practice Location | |||||||||
| Address1: | 52 WATER ST | ||||||||
| Address2: | |||||||||
| City: | THURMONT | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217881912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012713535 | ||||||||
| FaxNumber: | 3012712650 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 02/26/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD050724L | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | D0022819 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02244702 | 01 | PA | CAPITAL BLUE CROSS-WMG | OTHER | 107284 | 01 | PA | UNISON-WMG | OTHER | 153251100 | 05 | MD | MEDICAID | 20013087 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 2101377 | 01 | PA | MAMSI-WMG | OTHER | 307700 | 01 | MD | CAREFIRST MD BCBS | OTHER | 35172 | 01 | PA | GEISINGER | OTHER | 37475 | 01 | PA | JOHNS HOPKINS | OTHER | 4106017 | 01 | PA | AETNA | OTHER | P003004 | 01 | PA | GATEWAY-WMG | OTHER | 691655 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 001453216 | 05 | PA | MEDICAID |