Healthcare Provider Details

I. General information

NPI: 1932400801
Provider Name (Legal Business Name): WILLIAM H. COOPER, IV, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 MEDICAL CENTER DR
WILMINGTON NC
28401-7507
US

IV. Provider business mailing address

1500 MEDICAL CENTER DR
WILMINGTON NC
28401-7507
US

V. Phone/Fax

Practice location:
  • Phone: 910-763-9509
  • Fax: 910-763-1058
Mailing address:
  • Phone: 910-763-9509
  • Fax: 910-763-1058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number28957
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number28957
License Number StateNC

VIII. Authorized Official

Name: MS. ANN CHATFIELD
Title or Position: PRACTICE MANAGER
Credential: RN
Phone: 910-763-9509