Individual
DR. JASON A. COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
555 HERNDON PARKWAY, STE 100, HERNDON, VA 20170-4828
(703) 481-1505
(703) 742-8793
Mailing address
555 HERNDON PARKWAY, STE 100, HERNDON, VA 20170-4828
(703) 481-1505
(703) 742-8793
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101054352
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05622620
—
VA
01
—
080182902
RR MEDICARE
VA
Enumeration date
09/06/2005
Last updated
11/27/2023
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