Organization
COOPER PEDIATRIC SPECILAIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT MCMULLEN (EVP MANAGED CARE)
(856) 342-7263
Entity
Organization
Contact information
Practice address
3 COOPER PLZ, SUITE 200, CAMDEN, NJ 08103-1438
(856) 342-2001
Mailing address
3 COOPER PLZ, SUITE 502, CAMDEN, NJ 08103-1438
(856) 968-7433
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2128125000
AMERIHEALTH GRP #
NJ
05
—
3401901
—
NJ
Enumeration date
03/09/2007
Last updated
08/22/2020
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