Provider Demographics
NPI:1811981897
Name:COOK, JOHN HENRY III (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:HENRY
Last Name:COOK
Suffix:III
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:PO BOX 17334
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-1334
Mailing Address - Country:US
Mailing Address - Phone:703-443-6717
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:224D CORNWALL ST NW
Practice Address - Street 2:SUITE 102
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-2700
Practice Address - Country:US
Practice Address - Phone:703-777-1146
Practice Address - Fax:703-777-3144
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2010-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030448207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110204720OtherRR MEDICARE
VA05841771Medicaid
110007706Medicare PIN
VA05841771Medicaid