Provider Demographics
NPI:1972693612
Name:COOKE, LAURIE P (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:P
Last Name:COOKE
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:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:NEMOURS PEDIATRICS JESSUP ST.
Practice Address - Street 2:1602 JESSUP STREET
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-4210
Practice Address - Country:US
Practice Address - Phone:302-576-5050
Practice Address - Fax:302-576-5065
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10005054208000000X, 208D00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5442001Medicaid
DE001278T34Medicaid
PA001682596Medicaid
NJ7495307Medicaid
PA001682596Medicaid