Provider Demographics
NPI:1568462562
Name:COOK, GEORGE SPICER (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:SPICER
Last Name:COOK
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 1:309 COUNTY ROUTE 47
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-5405
Mailing Address - Country:US
Mailing Address - Phone:518-891-2688
Mailing Address - Fax:518-891-4120
Practice Address - Street 1:309 COUNTY ROUTE 47
Practice Address - Street 2:SUITE 1
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-5405
Practice Address - Country:US
Practice Address - Phone:518-891-2688
Practice Address - Fax:518-891-4120
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123651208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00459581Medicaid
NY1568462562OtherFIDELIS
NYDD2644OtherPALMETTO GBA
NY000401590001OtherBLUE SHIELD NENY
NY305201OtherBLUE CROSS BLUE SHIELD
NYP00000040480OtherGHI FHP
NYDD2644Medicare PIN
NYP00000040480OtherGHI FHP