Individual
DR. ROGER SCOTT COOLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 J CLYDE MORRIS BLVD, NEWPORT NEWS, VA 23601-1929
(757) 594-2000
(757) 826-9028
Mailing address
3998 FAIR RIDGE DR, SUITE 300, FAIRFAX, VA 22033-2921
(703) 295-9360
(703) 766-9725
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
30.016732
OH
207L00000X
Anesthesiology Physician
Primary
0101253918
VA
207L00000X
Anesthesiology Physician
35091962
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568646818
—
VA
05
—
2880888
—
OH
01
—
CO4245341
MEDICARE
OH
Enumeration date
12/21/2007
Last updated
03/27/2015
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