Organization
COOPER PEDIATRIC SPECIALIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT MCMULLEN (EVP MANGED CARE)
(856) 342-7263
Entity
Organization
Contact information
Practice address
6400 MAIN ST, VOORHEES, NJ 08043-4606
(856) 751-9339
Mailing address
3 COOPER PLZ, SUITE 502, CAMDEN, NJ 08103-1438
(856) 968-7433
Taxonomy
Speciality
Code
Description
License number
State
2080P0201X
Pediatric Allergy/Immunology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2123898000
AMERIHEALTH GRP #
NJ
05
—
9024603
—
NJ
Enumeration date
03/08/2007
Last updated
08/22/2020
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