Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301074004 | MI |
N | 2080P0207X | Pediatric Hematology-Oncologist | 35090984 | OH |
N | 2080P0207X | Pediatric Hematology-Oncologist | 4301074004 | MI |
Y | 2080P0207X | Pediatric Hematology-Oncologist | D76204 | MD |
NPI | 1104836733 |
---|---|
Provider Name | Kenneth Robert Cooke |
First Address | Baltimore, MD 21287-0001 |
Second Address | Baltimore, MD 21287-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 17/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000233275 | UNISON (01) | OH |
000000558054 | ANTHEM (01) | OH |
2146663 | (05) | OH |
4173898 | (05) | MI |
440046 | WELLCARE (01) | OH |
5752459 | AETNA (01) | OH |
753959 | BUCKEYE (01) | OH |
932856559A | (05) | GA |
F62327 | (02) |