Provider Demographics
NPI:1356314066
Name:COOPER, JANE D (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:D
Last Name:COOPER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1625 STRAITS TPKE
Mailing Address - Street 2:SUITE #301
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-1836
Mailing Address - Country:US
Mailing Address - Phone:203-573-9512
Mailing Address - Fax:203-568-2904
Practice Address - Street 1:1625 STRAITS TPKE
Practice Address - Street 2:SUITE #301
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-1836
Practice Address - Country:US
Practice Address - Phone:203-573-7281
Practice Address - Fax:203-573-7230
Is Sole Proprietor?:No
Enumeration Date:2006-02-12
Last Update Date:2012-10-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT030768207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001307678Medicaid
E42893Medicare UPIN
CT660000021Medicare ID - Type Unspecified