Provider Demographics
NPI:1710094610
Name:COOKE, LYNN A (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:A
Last Name:COOKE
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 1:1088 W BALTIMORE PIKE
Mailing Address - Street 2:SUITE #2208
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5146
Mailing Address - Country:US
Mailing Address - Phone:610-891-3900
Mailing Address - Fax:610-891-3919
Practice Address - Street 1:1088 W BALTIMORE PIKE
Practice Address - Street 2:SUITE #2208
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5146
Practice Address - Country:US
Practice Address - Phone:610-891-3900
Practice Address - Fax:610-891-3919
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD051484L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF88172Medicare UPIN
PA447238Medicare ID - Type Unspecified