Healthcare Provider Details

I. General information

NPI: 1700862570
Provider Name (Legal Business Name): ELIZABETH ELLEN COOLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 US ROUTE 202 RINDGE FAMILY PRACTICE
RINDGE NH
03461-7104
US

IV. Provider business mailing address

PO BOX 117
RINDGE NH
03461-0117
US

V. Phone/Fax

Practice location:
  • Phone: 603-899-9563
  • Fax: 603-899-9567
Mailing address:
  • Phone: 603-899-9563
  • Fax: 603-899-9567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9446
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: