Provider Demographics
NPI:1952311722
Name:COOK, LEWIS A (MD)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:A
Last Name:COOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5495 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25840-6872
Mailing Address - Country:US
Mailing Address - Phone:304-574-1888
Mailing Address - Fax:304-574-1891
Practice Address - Street 1:5495 MAPLE LANE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:WV
Practice Address - Zip Code:25840-1413
Practice Address - Country:US
Practice Address - Phone:304-574-1888
Practice Address - Fax:304-574-1891
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2013-10-14
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Provider Licenses
StateLicense IDTaxonomies
WV9864207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV1668EMedicare UPIN