Provider Demographics
NPI:1477749059
Name:GEORGE N. COOPER, JR. MD, LTD
Entity Type:Organization
Organization Name:GEORGE N. COOPER, JR. MD, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEROGE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-739-0011
Mailing Address - Street 1:1725 MENDON RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-4337
Mailing Address - Country:US
Mailing Address - Phone:401-334-2423
Mailing Address - Fax:
Practice Address - Street 1:1725 MENDON RD
Practice Address - Street 2:SUITE 207
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-4337
Practice Address - Country:US
Practice Address - Phone:401-334-2423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9001165Medicaid
RI9001165Medicaid