Provider Demographics
NPI:1922122274
Name:COOK, RANDALL C (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:C
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 1:1869 ROUTE 30 W
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-9239
Mailing Address - Country:US
Mailing Address - Phone:724-238-2167
Mailing Address - Fax:724-238-4074
Practice Address - Street 1:1869 ROUTE 30 W
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658
Practice Address - Country:US
Practice Address - Phone:724-238-2167
Practice Address - Fax:724-238-4074
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034451E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001078705Medicaid
PA185699Medicare PIN
PAC26879Medicare UPIN