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1790846038

NPI Code Detail

MEDICARE: SUSANNAH CATHERINE COOPER MD

MEDICARE: SUSANNAH CATHERINE 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	207RH0003X	Hematology & Oncology Physician	R5850	TX
2	207RH0003X	Hematology & Oncology Physician	0101242150	VA
3	207RH0003X	Hematology & Oncology Physician	62128	AZ
4	207RH0003X	Hematology & Oncology Physician	60670	TN

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	:	1790846038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANNAH CATHERINE COOPER MD

Provider Business Mailing Address
First Line	:	PO BOX 910221
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75391-0221
Country	:	US
Telephone Number	:	520-519-7700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1620 W SAINT MARYS RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-2624
Country	:	US
Telephone Number	:	520-624-7445
Fax Number	:	520-623-6145

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/05/2024

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Directions to “ SUSANNAH CATHERINE COOPER MD” Practice Location

Language	Start Address	Practice Location

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