Provider Demographics
NPI:1932343563
Name:COOPER, GLENN LAURENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:LAURENCE
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:196 OLD CONNECTICUT PATH
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-3124
Mailing Address - Country:US
Mailing Address - Phone:617-513-1049
Mailing Address - Fax:508-358-7558
Practice Address - Street 1:196 OLD CONNECTICUT PATH
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-3124
Practice Address - Country:US
Practice Address - Phone:617-513-1049
Practice Address - Fax:508-358-7558
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01061855A207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease