1720071095 NPI number — DR. TIMOTHY G COOK M.D.

Table of content: DR. TIMOTHY G COOK M.D. (NPI 1720071095)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720071095 NPI number — DR. TIMOTHY G COOK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOK
Provider First Name:
TIMOTHY
Provider Middle Name:
G
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:
1720071095
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 PARK STREET
Provider Second Line Business Mailing Address:
GLENS FALLS HOSPITAL - CREDENTIALING
Provider Business Mailing Address City Name:
GLENS FALLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12801-4413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-926-6992
Provider Business Mailing Address Fax Number:
802-775-3058

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
79 NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12832-1137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-642-0612
Provider Business Practice Location Address Fax Number:
518-642-0693
Provider Enumeration Date:
08/23/2005

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:  320347 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 173000000X , with the licence number: 042-0009268 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 080177542 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 49970 . This is a "BCBS VT" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: OVN2470 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 267562 . This is a "CIGNA" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 08066 . This is a "MVP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 58435 . This is a "BCBS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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