Provider Demographics
NPI:1639101389
Name:COOKE, JEFFRY A (PA-C)
Entity Type:Individual
Prefix:
First Name:JEFFRY
Middle Name:A
Last Name:COOKE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5275 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:GAP
Mailing Address - State:PA
Mailing Address - Zip Code:17527-9427
Mailing Address - Country:US
Mailing Address - Phone:717-442-8111
Mailing Address - Fax:717-442-8981
Practice Address - Street 1:5275 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:GAP
Practice Address - State:PA
Practice Address - Zip Code:17527-9427
Practice Address - Country:US
Practice Address - Phone:717-442-8111
Practice Address - Fax:717-442-8981
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051197363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P80901Medicare UPIN