Provider Demographics
NPI:1619328671
Name:COOKE, DOREAN A
Entity Type:Individual
Prefix:
First Name:DOREAN
Middle Name:A
Last Name:COOKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9849 ROYAL COMMERCE PL
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1159
Mailing Address - Country:US
Mailing Address - Phone:443-898-2819
Mailing Address - Fax:
Practice Address - Street 1:9849 ROYAL COMMERCE PL
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1159
Practice Address - Country:US
Practice Address - Phone:443-898-2819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0000000000251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health