Provider Demographics
NPI:1740596899
Name:COOK, ANTHONY CHARLES (DPM, MS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:CHARLES
Last Name:COOK
Suffix:
Gender:M
Credentials:DPM, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 COULTER AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2418
Mailing Address - Country:US
Mailing Address - Phone:215-990-0264
Mailing Address - Fax:
Practice Address - Street 1:121 COULTER AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-2418
Practice Address - Country:US
Practice Address - Phone:610-645-6314
Practice Address - Fax:610-645-9923
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006189213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASC006189OtherPA STATE LICENSE, PODIATRY