Provider Demographics
NPI:1790841617
Name:COOK, LANDY M (MD)
Entity Type:Individual
Prefix:
First Name:LANDY
Middle Name:M
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 1:606 DUTCHMANS LN
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3346
Mailing Address - Country:US
Mailing Address - Phone:410-763-8272
Mailing Address - Fax:410-763-6014
Practice Address - Street 1:606 DUTCHMANS LN
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3346
Practice Address - Country:US
Practice Address - Phone:410-763-8272
Practice Address - Fax:410-763-6014
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0060066208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
2115769OtherUNITED HEALTHCARE PRODUCT
MDW4320003OtherBLUE CHOICE
DE197116OtherCOVENTRY
3289852OtherAETNA
MD189837OtherAMERIGROUP
4304835OtherCIGNA
MD124901OtherPRIORITY PARTNERS
MD62013801OtherCAREFIRST
615474OtherNCPPO
MD189837OtherAMERIGROUP