1932106572 NPI number — THOMAS COOPER M.D.

Table of content: THOMAS COOPER M.D. (NPI 1932106572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932106572 NPI number — THOMAS COOPER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOPER
Provider First Name:
THOMAS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932106572
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
230 WORCESTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELLESLEY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02481-5420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-431-5255
Provider Business Mailing Address Fax Number:
781-431-5329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 WORCESTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLESLEY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02481-5420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-431-5255
Provider Business Practice Location Address Fax Number:
781-431-5329
Provider Enumeration Date:
06/28/2005

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: 207N00000X , with the licence number:  55056 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 055056 . This is a "TUFTS SECURE HORIZONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 27422 . This is a "CHILDREN'S MEDICAL SECURI" identifier . This identifiers is of the category "OTHER".
  • Identifier: J04908 . This is a "BLUE SHIELD INDEMNITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 055056 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4434 . This is a "HARVARD PILGRIM PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: B87206 . This is a "FIRST SENIORITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 055056 . This is a "TUFTS BENEFIT ADMIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 055056 . This is a "TUFTS COMMONWELATH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 070003328 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6692873 . This is a "CIGNA HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: J04908 . This is a "BS-BLUSE CARE ELECT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0016756 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 055056 . This is a "TUFTS TOTAL HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4434 . This is a "HARVARD PILGRIM POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 401052 . This is a "HARVARD/PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6174167 . This is a "MASS HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6692873 . This is a "HEALTHSOURCE-MA" identifier . This identifiers is of the category "OTHER".
  • Identifier: J04908 . This is a "HMO BLUE/BLUE CHOICE" identifier . This identifiers is of the category "OTHER".




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