Provider Demographics
NPI:1114957792
Name:COOK, ALBERT JAMES SR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:JAMES
Last Name:COOK
Suffix:SR
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 1:810 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44311-1518
Mailing Address - Country:US
Mailing Address - Phone:330-593-1049
Mailing Address - Fax:330-572-3836
Practice Address - Street 1:230 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:SEAMAN
Practice Address - State:OH
Practice Address - Zip Code:45679-8002
Practice Address - Country:US
Practice Address - Phone:330-593-1049
Practice Address - Fax:330-572-3836
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY433972085R0202X
OH35.0297032085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0311595Medicaid
PA100931107Medicaid
KY7100294730Medicaid
OHP00099068Medicare PIN
OH0311595Medicaid
OH4143552Medicare PIN
OH4025134Medicare PIN
PA079430SSJMedicare PIN
OH4025136Medicare PIN
OH4025135Medicare PIN
OH4025136Medicare PIN
OH4025139Medicare PIN
OH4025134Medicare PIN
PA079430WDGMedicare PIN
PA079430SSJMedicare PIN
OHP00099068Medicare PIN