Provider Demographics
NPI:1164524500
Name:COOK, DAVID WELLINGTON (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WELLINGTON
Last Name:COOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1300 3RD AVENUE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701
Mailing Address - Country:US
Mailing Address - Phone:304-522-1802
Mailing Address - Fax:304-529-6752
Practice Address - Street 1:1340 HAL GREER BLVD
Practice Address - Street 2:ATTN: TAMMIE SILVA
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3800
Practice Address - Country:US
Practice Address - Phone:304-522-1802
Practice Address - Fax:304-529-6752
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13810207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0096943000Medicaid
WV4319220OtherAETNA
WV001710114OtherBC
WV001720851OtherBLUE CROSS
WV0096943000Medicaid
WV4319220OtherAETNA
WV0096943000Medicaid