Individual
DEREK ROBERT COONEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
750 E ADAMS ST, UPSTATE EMERGENCY MEDICINE, SYRACUSE, NY 13210-2306
(315) 464-4363
(315) 464-8690
Mailing address
750 E ADAMS ST, UPSTATE EMERGENCY MEDICINE, SYRACUSE, NY 13210-2306
(315) 464-4363
(315) 464-8690
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
243861
NY
207P00000X
Emergency Medicine Physician
M0691
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02881712
—
NY
05
—
1721391-01
—
TX
01
—
1721391-02
CSHCN
TX
01
—
8P9119
BLUE SHIELD
TX
Enumeration date
04/05/2006
Last updated
01/07/2013
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