Provider Demographics
NPI:1720071095
Name:COOK, TIMOTHY G (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:G
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 1:100 PARK STREET
Mailing Address - Street 2:GLENS FALLS HOSPITAL - CREDENTIALING
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4413
Mailing Address - Country:US
Mailing Address - Phone:518-926-6992
Mailing Address - Fax:802-775-3058
Practice Address - Street 1:79 NORTH ST
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:NY
Practice Address - Zip Code:12832-1137
Practice Address - Country:US
Practice Address - Phone:518-642-0612
Practice Address - Fax:518-642-0693
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320347207Q00000X
VT042-0009268173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT080177542OtherRAILROAD MEDICARE
VT49970OtherBCBS VT
VTOVN2470Medicaid
VT267562OtherCIGNA
VT08066OtherMVP
VT58435OtherBCBS
VTOVN2470Medicaid
VT58435OtherBCBS