Provider Demographics
NPI:1336299551
Name:COOPER, VINCENT T (MD)
Entity Type:Individual
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First Name:VINCENT
Middle Name:T
Last Name:COOPER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:100 PARK STREET
Mailing Address - Street 2:GLENS FALLS HOSPITAL - CREDENTIALING
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4413
Mailing Address - Country:US
Mailing Address - Phone:518-926-5924
Mailing Address - Fax:518-926-6983
Practice Address - Street 1:14 HUDSON AVENUE
Practice Address - Street 2:SURGICAL SPECIALISTS OF GLENS FALLS HOSPIAL
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801
Practice Address - Country:US
Practice Address - Phone:518-926-5600
Practice Address - Fax:518-926-5605
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2021-08-30
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Provider Licenses
StateLicense IDTaxonomies
NY236133208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02647863Medicaid
NYJ400221420Medicare PIN
NY02647863Medicaid