Provider Demographics
NPI:1710908173
Name:COOK, JAMES WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILLIAM
Last Name:COOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 PENNSYLVANIA AVE NW STE 6B-412
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-3201
Mailing Address - Country:US
Mailing Address - Phone:202-741-3225
Mailing Address - Fax:704-226-1236
Practice Address - Street 1:2150 PENNSYLVANIA AVE NW STE 6B-412
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-3201
Practice Address - Country:US
Practice Address - Phone:202-741-3225
Practice Address - Fax:704-226-1236
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01880208600000X
VA0101257791208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902874Medicaid
SC272804Medicaid
NC1710908173Medicaid
NC2050502AMedicare PIN
NC2050502Medicare PIN
NCH88834Medicare UPIN
SC272804Medicaid