Healthcare Provider Details

I. General information

NPI: 1174718480
Provider Name (Legal Business Name): DIANA CONSTANZA KOOPER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 7TH ST N
NAPLES FL
34102-5754
US

IV. Provider business mailing address

PO BOX 112019
NAPLES FL
34108-0134
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-3997
  • Fax: 239-624-8101
Mailing address:
  • Phone:
  • Fax: 239-624-0464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101259408
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number48309
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number48309
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101259408
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME104136
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: