Provider Demographics
NPI:1841289675
Name:COOK, JOLANDA IRMA (MD)
Entity type:Individual
Prefix:DR
First Name:JOLANDA
Middle Name:IRMA
Last Name:COOK
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 1:617 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-9700
Mailing Address - Country:US
Mailing Address - Phone:276-628-1186
Mailing Address - Fax:276-628-8507
Practice Address - Street 1:617 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-9700
Practice Address - Country:US
Practice Address - Phone:276-628-1186
Practice Address - Fax:276-628-8507
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010154523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005641802Medicaid
03OtherJD
5756306OtherAETNA
2102748OtherMAMSI
226900OtherANTHEM
080007095Medicare ID - Type Unspecified
5756306OtherAETNA