Healthcare Provider Details

I. General information

NPI: 1366499097
Provider Name (Legal Business Name): RAMACHANDIRAN COOPPAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JOSLIN PL
BOSTON MA
02215-5306
US

IV. Provider business mailing address

1 JOSLIN PL
BOSTON MA
02215-5306
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-2400
  • Fax:
Mailing address:
  • Phone: 617-732-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number39906
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: