MEDICARE: SEAN THOMAS COOK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	229757	PA
2	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1275097156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN THOMAS COOK

Provider Business Mailing Address
First Line	:	421 COLLEGE PARK DR
Second Line	:
City	:	MONROEVILLE
State	:	PA
Zip	:	15146-1535
Country	:	US
Telephone Number	:	412-689-1208
Fax Number	:

Provider Business Practice Location Address
First Line	:	421 COLLEGE PARK DR
Second Line	:
City	:	MONROEVILLE
State	:	PA
Zip	:	15146-1535
Country	:	US
Telephone Number	:	412-689-1208
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2019
Last Update Date	:	07/09/2020

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Directions to “ SEAN THOMAS COOK ” Practice Location

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