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NPI Code Detail

MEDICARE: EAST COOPER PHYSICIAN GROUP LLC

MEDICARE: EAST COOPER PHYSICIAN GROUP LLC
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
12085R0202XDiagnostic Radiology Physician

General Provider Information

NPI Number : 1114893096
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAST COOPER PHYSICIAN GROUP LLC
Provider Business Mailing Address
First Line : PO BOX 37642
Second Line :
City : BELFAST
State : ME
Zip : 04915-1218
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2000 HOSPITAL DR
Second Line :
City : MT PLEASANT
State : SC
Zip : 29464-3764
Country : US
Telephone Number : 843-881-0100
Fax Number :
Authorized Official
Title or Position : RCS MANAGER
Name : LEEA JEANINE WALTON
Credential :
Telephone Number : 704-316-6081
Provider Enumeration Date : 10/16/2025
Last Update Date : 12/16/2025

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