Provider Demographics
NPI:1013978261
Name:COOKE-SAMPSON, ESTELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ESTELLE
Middle Name:
Last Name:COOKE-SAMPSON
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 1:2041 GEORGIA AVE NW STE 6101
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20060-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2041 GEORGIA AVE NW STE 6101
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-5441
Practice Address - Country:US
Practice Address - Phone:202-865-6679
Practice Address - Fax:202-865-3138
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD118292085R0202X
MDD00323312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD387951802Medicaid
MDKA80OtherB/C B/S
DC021654800Medicaid
MDJ062OtherB/C B/S
DC2849OtherB/C B/S
MD387951802Medicaid
MDE88451Medicare UPIN
MD012698A00Medicare ID - Type UnspecifiedLOCALITY/JURIS. CODE 99
DC2849OtherB/C B/S
MDKA80OtherB/C B/S
MDCD4495Medicare ID - Type UnspecifiedRAILROAD MEDICARE