Provider Demographics
NPI:1790988335
Name:COOPER, MARY REICH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:REICH
Last Name:COOPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9 WACCABUC RIVER LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:10590-1117
Mailing Address - Country:US
Mailing Address - Phone:914-763-2145
Mailing Address - Fax:914-470-2570
Practice Address - Street 1:9 WACCABUC RIVER LN
Practice Address - Street 2:
Practice Address - City:SOUTH SALEM
Practice Address - State:NY
Practice Address - Zip Code:10590-1117
Practice Address - Country:US
Practice Address - Phone:914-763-2145
Practice Address - Fax:914-470-2570
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY60-197374207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine