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
1	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1285496026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST COOPER PHYSICIAN GROUP LLC

Provider Business Mailing Address
First Line	:	PO BOX 604408
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-4408
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 HOSPITAL DR STE 370
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-5293
Country	:	US
Telephone Number	:	999-999-9999
Fax Number	:

Authorized Official
Title or Position	:	RCS MANAGER
Name	:	DOREATHA ROGERS
Credential	:
Telephone Number	:	980-302-7992

Provider Enumeration Date	:	01/26/2024
Last Update Date	:	02/28/2026

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