Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MD036765E | PA |
N | 207PE0004X | Emergency Medical Services | MD036765E | PA |
N | 207PP0204X | Pediatric Emergency Physician | MD036765E | PA |
NPI | 1578505459 |
---|---|
Provider Name | Richard T Cook JR. |
First Address | Hummelstown, PA 17036-8987 |
Second Address | Hummelstown, PA 17036-8987 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 14/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0010934340020 | (05) | PA |
C33296 | (02) |