Provider Demographics
NPI:1235163346
Name:COOK, VICTORIA L (MD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:L
Last Name:COOK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104
Mailing Address - Country:US
Mailing Address - Phone:413-739-5676
Mailing Address - Fax:413-739-2278
Practice Address - Street 1:2150 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3300
Practice Address - Country:US
Practice Address - Phone:413-739-5676
Practice Address - Fax:413-739-2278
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72720207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA11531OtherHEALTH NEW ENGLAND
MA3063411Medicaid
MA072720OtherTUFTS HEALTH PLAN
MAJ11462OtherBLUE CROSS BLUE SHIELD MA
MA3063411Medicaid
MA072720OtherTUFTS HEALTH PLAN