Healthcare Provider Details

I. General information

NPI: 1366631079
Provider Name (Legal Business Name): BENJAMIN COOPER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 OGLETOWN STANTON RD MAP 1 SUITE 137
NEWARK DE
19713-2067
US

IV. Provider business mailing address

4745 OGLETOWN STANTON RD MAP 1 SUITE 137
NEWARK DE
19713-2067
US

V. Phone/Fax

Practice location:
  • Phone: 302-652-3331
  • Fax:
Mailing address:
  • Phone: 302-652-3331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberC10006632
License Number StateDE

VIII. Authorized Official

Name: BENJAMIN COOPER
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 302-652-3331