MEDICARE: DR. KAREN COOPER M.D.

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	207R00000X	Internal Medicine Physician	1615661	NY

General Provider Information

NPI Number	:	1780632869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN COOPER M.D.

Provider Business Mailing Address
First Line	:	1927 SARANAC AVE
Second Line	:	SUITE 100
City	:	LAKE PLACID
State	:	NY
Zip	:	12946-1112
Country	:	US
Telephone Number	:	518-523-7575
Fax Number	:	518-523-7577

Provider Business Practice Location Address
First Line	:	1927 SARANAC AVE
Second Line	:	SUITE 100
City	:	LAKE PLACID
State	:	NY
Zip	:	12946-1112
Country	:	US
Telephone Number	:	518-523-7575
Fax Number	:	518-523-7577

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	02/28/2008

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