Healthcare Provider Details

I. General information

NPI: 1487650867
Provider Name (Legal Business Name): BENJAMIN COOPER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 LIMESTONE RD STE 101
WILMINGTON DE
19808-5413
US

IV. Provider business mailing address

1941 LIMESTONE RD STE 101
WILMINGTON DE
19808-5413
US

V. Phone/Fax

Practice location:
  • Phone: 302-655-9494
  • Fax: 302-691-1478
Mailing address:
  • Phone: 302-655-9494
  • Fax: 302-691-1478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberC10006632
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: