Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | D74065 | MD |
NPI | 1013182963 |
---|---|
Provider Name | Stacy Lorine Cooper |
First Address | Middle River, MD 21220-2004 |
Second Address | Baltimore, MD 21287-0005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2008 |
Last Update Date | 09/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D74065 | LICENSE (01) | MD |