MEDICARE: COOPER PHYSICIAN OFFICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0736144027	OTHER	NJ	AMERI GRP#

General Provider Information

NPI Number	:	1063616399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COOPER PHYSICIAN OFFICES

Provider Business Mailing Address
First Line	:	3 COOPER PLZ
Second Line	:	SUITE 502
City	:	CAMDEN
State	:	NJ
Zip	:	08103-1438
Country	:	US
Telephone Number	:	856-342-2921
Fax Number	:	856-968-8499

Provider Business Practice Location Address
First Line	:	196 GROVE AVE
Second Line	:	SUITE C
City	:	THOROFARE
State	:	NJ
Zip	:	08086-2139
Country	:	US
Telephone Number	:	856-848-7577
Fax Number	:	856-848-6554

Authorized Official
Title or Position	:	EVP MANAGED CARE
Name	:	ROBERT MCMULLEN
Credential	:
Telephone Number	:	856-342-2921

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	08/22/2020

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