Provider Demographics
NPI:1811970056
Name:COOK, RICHARD EUGENE JR (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:EUGENE
Last Name:COOK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:BRYANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20617-0215
Mailing Address - Country:US
Mailing Address - Phone:301-472-4290
Mailing Address - Fax:240-607-3609
Practice Address - Street 1:3450 OLD WASHINGTON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3248
Practice Address - Country:US
Practice Address - Phone:301-472-4290
Practice Address - Fax:240-607-3609
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2024-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063483207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI43891Medicare UPIN
MDM715Medicare PIN