1134362478 NPI number — MRS. CLAIRICE ANN COOPER MD (AS OF 5/1/09)

Table of content: MRS. CLAIRICE ANN COOPER MD (AS OF 5/1/09) (NPI 1134362478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134362478 NPI number — MRS. CLAIRICE ANN COOPER MD (AS OF 5/1/09)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOPER
Provider First Name:
CLAIRICE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD (AS OF 5/1/09)
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAKKER
Provider Other First Name:
CLAIRICE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134362478
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
462 GRIDER ST
Provider Second Line Business Mailing Address:
DEPT. OF SURGERY - MILLER BLDG.
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14215-3021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-898-5186
Provider Business Mailing Address Fax Number:
716-898-3194

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
462 GRIDER ST
Provider Second Line Business Practice Location Address:
DEPT. OF SURGERY - MILLER BLDG.
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14215-3021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-898-5186
Provider Business Practice Location Address Fax Number:
716-898-3194
Provider Enumeration Date:
04/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  275399 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com