Healthcare Provider Details

I. General information

NPI: 1942296561
Provider Name (Legal Business Name): HUGH MARK COOPER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SOUTH ST SUITE 200
SOUTHBRIDGE MA
01550-4051
US

IV. Provider business mailing address

100 SOUTH ST SUITE 200
SOUTHBRIDGE MA
01550-4051
US

V. Phone/Fax

Practice location:
  • Phone: 508-764-4400
  • Fax: 508-764-3300
Mailing address:
  • Phone: 508-764-4400
  • Fax: 508-764-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number153361
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number153361
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: