Basic Information
| Provider Information | |||||||||
| NPI: | 1992734503 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOPER | ||||||||
| FirstName: | TERI | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 725 NORTH ST | ||||||||
| Address2: | BERKSHIRE MEDICAL CENTER LABORATORY | ||||||||
| City: | PITTSFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012014132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4134472598 | ||||||||
| FaxNumber: | 4133957622 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 NORTH ST | ||||||||
| Address2: | BERKSHIRE MEDICAL CENTER LABORATORY | ||||||||
| City: | PITTSFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012014132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4134472598 | ||||||||
| FaxNumber: | 4133957622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 55535 | MA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 3040216 | 05 | MA | MEDICAID | J07355 | 01 | MA | MA BC/BS | OTHER |