Healthcare Provider Details

I. General information

NPI: 1346652443
Provider Name (Legal Business Name): CHARLENE AYDEN COOPER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AYDEN COOPER

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 11/14/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7156 W COLONIAL DR FL 32818
ORLANDO FL
32818-6751
US

IV. Provider business mailing address

6850 LAKE NONA BLVD
ORLANDO FL
32827-7408
US

V. Phone/Fax

Practice location:
  • Phone: 863-242-3322
  • Fax:
Mailing address:
  • Phone: 407-266-1106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME138325
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN20054
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME138325
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: