Provider Demographics
NPI:1629598685
Name:COOK, MOLLY ANNE (MD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANNE
Last Name:COOK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BREWSTER ST
Mailing Address - Street 2:FCC A
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860
Mailing Address - Country:US
Mailing Address - Phone:401-729-2304
Mailing Address - Fax:401-729-2541
Practice Address - Street 1:111 BREWSTER ST
Practice Address - Street 2:FCC A
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860
Practice Address - Country:US
Practice Address - Phone:401-729-2304
Practice Address - Fax:401-729-2541
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RILP04115207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RILP04115OtherRHODE ISLAND MEDICAL LICENSE