Provider Demographics
NPI:1023003134
Name:DARRELL, THOMAS COOK (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:COOK
Last Name:DARRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 N JUDD PKWY NE
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-2374
Mailing Address - Country:US
Mailing Address - Phone:919-552-2292
Mailing Address - Fax:919-557-7668
Practice Address - Street 1:431 N JUDD PKWY NE
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2374
Practice Address - Country:US
Practice Address - Phone:919-552-2292
Practice Address - Fax:919-557-7668
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30142207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC30142OtherSTATE LICENSE NUMBER
NC8927074Medicaid
NC8927074Medicaid
NCC64670Medicare UPIN