Individual
DR. GRACE N KOOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
680 CENTRE ST, BROCKTON, MA 02302-3308
(808) 941-7228
(508) 941-6401
Mailing address
28 WILLIS DR, CUMBERLAND, RI 02864-2066
(401) 258-1667
Taxonomy
Speciality
Code
Description
License number
State
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
78340
MA
2084P0800X
Psychiatry Physician
Primary
78340
MA
2084P0800X
Psychiatry Physician
MD09334
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110055852A
—
MA
05
—
3139123
—
MA
Enumeration date
01/05/2006
Last updated
04/25/2023
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