Healthcare Provider Details

I. General information

NPI: 1316092133
Provider Name (Legal Business Name): GARGI B. COOPER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 UNION ST
LYNN MA
01901-1314
US

IV. Provider business mailing address

269 UNION ST
LYNN MA
01901-1314
US

V. Phone/Fax

Practice location:
  • Phone: 781-596-2502
  • Fax: 781-596-3966
Mailing address:
  • Phone: 781-598-3900
  • Fax: 781-598-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number252218
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: