Provider Demographics
NPI:1861681942
Name:JOHN W COOK DPM, LTD
Entity Type:Organization
Organization Name:JOHN W COOK DPM, LTD
Other - Org Name:CENTRAL VIRGINIA PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:540-898-6500
Mailing Address - Street 1:4103 LAFAYETTE BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-4274
Mailing Address - Country:US
Mailing Address - Phone:540-898-6500
Mailing Address - Fax:540-834-0363
Practice Address - Street 1:4103 LAFAYETTE BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-4274
Practice Address - Country:US
Practice Address - Phone:540-898-6500
Practice Address - Fax:540-834-0363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000800213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC04909Medicare PIN
VA0506670001Medicare NSC
CI1841Medicare PIN