Provider Demographics
NPI:1912074766
Name:COOK, MARILUE M (MD)
Entity Type:Individual
Prefix:
First Name:MARILUE
Middle Name:M
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 1:2706 MEDICAL OFFICE PLACE
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9460
Mailing Address - Country:US
Mailing Address - Phone:919-734-4736
Mailing Address - Fax:919-580-1017
Practice Address - Street 1:2706 MEDICAL OFFICE PLACE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9460
Practice Address - Country:US
Practice Address - Phone:919-734-4736
Practice Address - Fax:919-580-1017
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38917208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
47156OtherMEDCOST
23882OtherBCBS
47156OtherMEDCOST
E74597Medicare UPIN