MEDICARE: KYLE A. COOPER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	226920	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053313197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE A. COOPER MD

Provider Business Mailing Address
First Line	:	280 CHESTNUT ST FL 2
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01199-1001
Country	:	US
Telephone Number	:	413-794-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	325B KING ST
Second Line	:
City	:	NORTHAMPTON
State	:	MA
Zip	:	01060-2370
Country	:	US
Telephone Number	:	413-794-2273
Fax Number	:	413-387-4136

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	11/15/2022

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