Provider Demographics
NPI:1902356207
Name:COOPER, RACHEL LINDSAY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:LINDSAY
Last Name:COOPER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:LINDSAY
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:
Practice Address - Street 1:443 NORTHFIELD AVE STE 204
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-3093
Practice Address - Country:US
Practice Address - Phone:732-246-3066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00630700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant