Provider Demographics
NPI:1750344875
Name:COOPER, HECTOR WAYNE (MD)
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:WAYNE
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6275 E VIRGINIA BEACH BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-2851
Mailing Address - Country:US
Mailing Address - Phone:757-466-0089
Mailing Address - Fax:757-466-8017
Practice Address - Street 1:600 GRESHAM DR STE 700
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-388-3000
Practice Address - Fax:423-826-1290
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2001006652085R0202X
VA01012598792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89128WAMedicaid
NC128WAOtherBCBS
NCH35740Medicare UPIN
NC2285663AMedicare PIN
NC300136808Medicare PIN