MEDICARE: CHARLENE AYDEN 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	208600000X	Surgery Physician	ME138325	FL
2	390200000X	Student in an Organized Health Care Education/Training Program	TRN20054	FL
3	207R00000X	Internal Medicine Physician	ME138325	FL

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	:	1346652443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLENE AYDEN COOPER MD

Provider Business Mailing Address
First Line	:	6850 LAKE NONA BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32827-7408
Country	:	US
Telephone Number	:	407-266-1106
Fax Number	:

Provider Business Practice Location Address
First Line	:	7156 W COLONIAL DR FL 32818
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-6751
Country	:	US
Telephone Number	:	863-242-3322
Fax Number	:

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

Provider Enumeration Date	:	05/22/2014
Last Update Date	:	11/14/2022

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Directions to “ CHARLENE AYDEN COOPER MD” Practice Location

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