Individual
SALLY A. COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
123 ANDOVER RD, WESTBROOK, ME 04092-3848
(207) 761-2200
(207) 761-2108
Mailing address
78 ATLANTIC PL, SOUTH PORTLAND, ME 04106-2316
(207) 661-6654
(207) 842-7773
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD14099
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013070580
—
ME
05
—
104540000
—
ME
Enumeration date
12/18/2006
Last updated
10/03/2016
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