Provider Demographics
NPI:1578563706
Name:COOK, TERI LIANE (MD)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:LIANE
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:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:807 FARSON ST.
Practice Address - Street 2:SUITE 203
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1009
Practice Address - Country:US
Practice Address - Phone:740-423-9640
Practice Address - Fax:740-423-9648
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.087090208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810004350Medicaid
OH2617270Medicaid
OH2617270Medicaid
OH000000383385OtherANTHEM
OH000000699808OtherANTHEM
OH2617270Medicaid
4174062Medicare PIN