Provider Demographics
NPI:1275665531
Name:COOK, CHRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
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 1:5801 BREMO RD
Mailing Address - Street 2:ST. MARY'S HOSPITAL
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1907
Mailing Address - Country:US
Mailing Address - Phone:804-281-8222
Mailing Address - Fax:804-281-8007
Practice Address - Street 1:5801 BREMO RD
Practice Address - Street 2:ST. MARY'S HOSPITAL
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1907
Practice Address - Country:US
Practice Address - Phone:804-281-8222
Practice Address - Fax:804-281-8007
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19623208000000X
VA0101243792208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1275665531Medicaid