Provider Demographics
NPI:1124143938
Name:COOPER, STEVEN L (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
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 1:225 MAYNARD RD
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-1211
Mailing Address - Country:US
Mailing Address - Phone:860-466-1059
Mailing Address - Fax:
Practice Address - Street 1:LINCOLN NATIONAL LIFE INSURANC
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103-1106
Practice Address - Country:US
Practice Address - Phone:860-466-1059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54771207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine