Provider Demographics
NPI:1891714606
Name:COOK, JUDITH W (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:W
Last Name:COOK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 DUNN RD
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:ME
Mailing Address - Zip Code:04917-4227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:511 DUNN RD
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:ME
Practice Address - Zip Code:04917-4227
Practice Address - Country:US
Practice Address - Phone:207-495-2249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH247762086S0129X
WAMD00042686208600000X
VA01012814702086S0129X
PAMD4335392086S0129X
WI10782086S0129X
TN592332086S0129X
MEMD214782086S0129X
IN01082357A2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8855960Medicare PIN