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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
1207V00000XObstetrics & Gynecology Physician

General Provider Information

NPI Number : 1972374684
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 : 851 LEONARD FULGHUM DR STE 200
Second Line :
City : MT PLEASANT
State : SC
Zip : 29464-3793
Country : US
Telephone Number : 843-856-3262
Fax Number : 843-856-3268
Authorized Official
Title or Position : RCS MANAGER
Name : DOREATHA ROGERS
Credential :
Telephone Number : 980-302-7992
Provider Enumeration Date : 01/11/2024
Last Update Date : 01/22/2024

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Directions to “EAST COOPER PHYSICIAN GROUP LLC ” Practice Location

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