Provider Demographics
NPI:1487874962
Name:COOPER, ERIN LOUISE (MD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:LOUISE
Last Name:COOPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 EXECUTIVE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-4875
Mailing Address - Country:US
Mailing Address - Phone:859-927-3741
Mailing Address - Fax:859-305-3040
Practice Address - Street 1:2240 EXECUTIVE DR STE 102
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505
Practice Address - Country:US
Practice Address - Phone:859-927-3741
Practice Address - Fax:859-305-3040
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48477207QG0300X, 207Q00000X
KYTP594207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine