Deidre Monique Cooperwood, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

300 Tuskegee Blvd
Dover Afb, DE 19902-5003

Phone

(302) 677-2600

NPI assigned

Oct 1, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1412121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658707200000",
    "number": "1083017362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 TUSKEGEE BLVD",
            "city": "DOVER AFB",
            "state": "DE",
            "postal_code": "199025003",
            "telephone_number": "302-677-2600",
            "fax_number": "302-677-5196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 TUSKEGEE BLVD",
            "city": "DOVER AFB",
            "state": "DE",
            "postal_code": "199025003",
            "telephone_number": "302-677-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPERWOOD",
        "first_name": "DEIDRE",
        "middle_name": "MONIQUE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-01",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gabrielle Christine Brow, DO
• Carmelita Burns-Wilson, LCSW
• Nicole M Campbell, PHD
• Matthew John Cazan Jr., MD
• Denise Inga Coleman, MSW
• Geoffrey Wallace Crawley, M.D.
• Nyemade Cummings-Swen, PSY.D
• Lindsey Dean, DMD
• Tara Lynn Dick, LCSW
• Peggy Lee Dickson, D.D.S.

• All providers in Dover Afb, DE
• Physician Assistant in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.