Healthcare Provider Details

I. General information

NPI: 1992739726
Provider Name (Legal Business Name): ROBERT J COOPER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 03/28/2024
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HOSPITAL DR STE 104
HOLYOKE MA
01040-6603
US

IV. Provider business mailing address

20 CHERRY LN
LONGMEADOW MA
01106-1608
US

V. Phone/Fax

Practice location:
  • Phone: 413-534-2820
  • Fax:
Mailing address:
  • Phone: 413-387-5971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number71829
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number204180
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: