Provider Demographics
NPI:1821077330
Name:COOK-MOINE, COLLEEN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:LEE
Last Name:COOK-MOINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:71 SPRING HILL LN
Mailing Address - Street 2:
Mailing Address - City:MOUNTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17554-1065
Mailing Address - Country:US
Mailing Address - Phone:717-285-4145
Mailing Address - Fax:717-569-3903
Practice Address - Street 1:1725 OREGON PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4206
Practice Address - Country:US
Practice Address - Phone:717-569-8518
Practice Address - Fax:717-569-3903
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD046891L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics