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NPI Code Detail

MEDICARE: DR. JIADI WANG COOK M.D.

MEDICARE: DR. JIADI WANG COOK M.D.
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
1207Q00000XFamily Medicine Physician0101258290VA

General Provider Information

NPI Number : 1861784043
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JIADI WANG COOK M.D.
Provider Business Mailing Address
First Line : 1501 SENTINEL DR STE 407
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23320-4471
Country : US
Telephone Number : 757-276-7585
Fax Number : 877-485-8290
Provider Business Practice Location Address
First Line : 1818 E WINDSOR RD
Second Line :
City : URBANA
State : IL
Zip : 61802-9566
Country : US
Telephone Number : 217-255-9646
Fax Number : 217-326-1777
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2011
Last Update Date : 03/17/2026

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