Provider Demographics
NPI:1780852129
Name:COOK & SIU PC
Entity Type:Organization
Organization Name:COOK & SIU PC
Other - Org Name:RICHARD E COOK, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:COOK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:301-472-9240
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:BRYANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20617-0215
Mailing Address - Country:US
Mailing Address - Phone:301-472-4290
Mailing Address - Fax:301-290-5287
Practice Address - Street 1:29015 THREE NOTCH RD
Practice Address - Street 2:SUITE 1-A
Practice Address - City:MECHANICSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20659-3228
Practice Address - Country:US
Practice Address - Phone:301-472-4290
Practice Address - Fax:301-290-5287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063483207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI43891Medicare UPIN