Provider Demographics
NPI:1316902224
Name:COOLER, HENRY P (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:P
Last Name:COOLER
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 1:320 MIDLAND PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8113
Mailing Address - Country:US
Mailing Address - Phone:843-873-5577
Mailing Address - Fax:843-873-5583
Practice Address - Street 1:320 MIDLAND PKWY STE A
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8113
Practice Address - Country:US
Practice Address - Phone:843-873-5577
Practice Address - Fax:843-873-5583
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5348207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC180002975OtherRAILROAD MEDICARE
SC053480Medicaid
SC180002975OtherRAILROAD MEDICARE
SC053480Medicaid
SC5912Medicare PIN
SC5910Medicare PIN
SC5911Medicare PIN