Provider Demographics
NPI:1992031801
Name:COOKE, JOHN (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:COOKE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:215 TOLL GATE RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4458
Mailing Address - Country:US
Mailing Address - Phone:401-739-9050
Mailing Address - Fax:401-732-2203
Practice Address - Street 1:215 TOLL GATE RD
Practice Address - Street 2:SUITE 206
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4458
Practice Address - Country:US
Practice Address - Phone:401-739-9050
Practice Address - Fax:401-732-2203
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIPA00017363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant