Provider Demographics
NPI:1932400801
Name:WILLIAM H. COOPER, IV, MD, PA
Entity Type:Organization
Organization Name:WILLIAM H. COOPER, IV, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHATFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:910-763-9509
Mailing Address - Street 1:1500 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7507
Mailing Address - Country:US
Mailing Address - Phone:910-763-9509
Mailing Address - Fax:910-763-1058
Practice Address - Street 1:1500 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7507
Practice Address - Country:US
Practice Address - Phone:910-763-9509
Practice Address - Fax:910-763-1058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28957207VE0102X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC1998Medicare UPIN