Organization
COOPER PEDIATRIC SPECIALISTS
Active
Organization
COOPER PEDIATRIC SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT MCMULLEN (EVP MANAGED CARE)
(856) 342-7263
Entity
Organization
Contact information
Practice address
110 MARTER AVE, SUITE 402, MOORESTOWN, NJ 08057-3124
(856) 722-9551
Mailing address
3 COOPER PLZ, SUITE 502, CAMDEN, NJ 08103-1438
(856) 968-7433
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2126166000
AMERIHEALTH GRP NUMBER
—
05
—
9024603
—
NJ
Enumeration date
03/15/2007
Last updated
08/22/2020
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