Provider Demographics
NPI:1871504407
Name:COOK, GREGORY DALE (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DALE
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 1:26 HIGH MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-1853
Mailing Address - Country:US
Mailing Address - Phone:814-231-7868
Mailing Address - Fax:
Practice Address - Street 1:26 HIGH MEADOW LN
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-1853
Practice Address - Country:US
Practice Address - Phone:814-231-7868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024141-E207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine