Provider Demographics
NPI:1912999822
Name:COOK, AMANDA (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
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 1:111 HAZEL LANE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1253
Mailing Address - Country:US
Mailing Address - Phone:412-741-5577
Mailing Address - Fax:412-741-1141
Practice Address - Street 1:111 HAZEL LANE
Practice Address - Street 2:SUITE 102
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1253
Practice Address - Country:US
Practice Address - Phone:412-741-5577
Practice Address - Fax:412-741-1141
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425883207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012902200001Medicaid
PAC01736310OtherBLUE SHIELD PROVIDER
PAC01736310OtherBLUE SHIELD PROVIDER
PA1012902200001Medicaid