Provider Demographics
NPI:1275517922
Name:COOPER, MICHELLE H (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:H
Last Name:COOPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BANNING STREET
Mailing Address - Street 2:SUITE 320
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3530
Mailing Address - Country:US
Mailing Address - Phone:302-674-0223
Mailing Address - Fax:302-674-0109
Practice Address - Street 1:200 BANNING STREET
Practice Address - Street 2:SUITE 320
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3530
Practice Address - Country:US
Practice Address - Phone:302-674-0223
Practice Address - Fax:302-674-0109
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10005703207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000969701Medicaid
DE016925077Medicare ID - Type Unspecified
DE0000969701Medicaid