Provider Demographics
NPI:1699769372
Name:KOOP, JENNIFER (MD)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:KOOP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:100 CAMPUS DR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5892
Mailing Address - Country:US
Mailing Address - Phone:603-422-8208
Mailing Address - Fax:603-422-8218
Practice Address - Street 1:100 CAMPUS DR
Practice Address - Street 2:SUITE 12
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5892
Practice Address - Country:US
Practice Address - Phone:603-422-8208
Practice Address - Fax:603-422-8218
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH11629207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3073175Medicaid
NHH72091Medicare UPIN
NHRE6946Medicare ID - Type Unspecified