Healthcare Provider Details

I. General information

NPI: 1023221082
Provider Name (Legal Business Name): JEREMY JOSEPH COOK D.P.M., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 CONCORD AVE, SUITE 3600
CAMBRIDGE MA
02138
US

IV. Provider business mailing address

725 CONCORD AVE STE 3600
CAMBRIDGE MA
02138-1040
US

V. Phone/Fax

Practice location:
  • Phone: 617-354-3131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2328
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License Number2328
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number2328
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number2328
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number2328
License Number StateMA
# 6
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2328
License Number StateMA
# 7
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number2328
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: