1760529366 NPI number — DR. STEPHEN ELBRIDGE COOK M.D.

Table of content: DR. STEPHEN ELBRIDGE COOK M.D. (NPI 1760529366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760529366 NPI number — DR. STEPHEN ELBRIDGE COOK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOK
Provider First Name:
STEPHEN
Provider Middle Name:
ELBRIDGE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760529366
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 FISHER RD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLDEN
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-843-6177
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
185 TOWNSEND AVE STE R
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOOTHBAY HARBOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04538-1895
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-633-1075
Provider Business Practice Location Address Fax Number:
207-633-1067
Provider Enumeration Date:
01/31/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD9665 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207P00000X , with the licence number: 009665 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)