Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 0101042717 | VA |
NPI | 1013973049 |
---|---|
Provider Name | Gregory W. Cooper |
First Address | Charlottesville, VA 22906-9007 |
Second Address | Charlottesville, VA 22908-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 16/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E55515 | (02) | PA |