Provider Demographics
NPI:1689623829
Name:ALICIA A COOL MD PA
Entity Type:Organization
Organization Name:ALICIA A COOL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:COOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-339-5300
Mailing Address - Street 1:6701 N CHARLES ST
Mailing Address - Street 2:5201
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6808
Mailing Address - Country:US
Mailing Address - Phone:410-339-5300
Mailing Address - Fax:410-339-7127
Practice Address - Street 1:6701 N CHARLES ST
Practice Address - Street 2:5201
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-6808
Practice Address - Country:US
Practice Address - Phone:410-339-5300
Practice Address - Fax:410-339-7127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-06
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD30717207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00001030OtherRAILROAD MEDICARE
MDB69093Medicare UPIN
MD596MMedicare PIN
B69093Medicare UPIN