Healthcare Provider Details

I. General information

NPI: 1073806089
Provider Name (Legal Business Name): WALDORF WOMENS CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4470 REGENCY PL SUITE 106
WHITE PLAINS MD
20695-3071
US

IV. Provider business mailing address

PO BOX 1100
WHITE PLAINS MD
20695-1100
US

V. Phone/Fax

Practice location:
  • Phone: 240-252-2140
  • Fax: 240-252-2141
Mailing address:
  • Phone: 240-252-2140
  • Fax: 240-252-2141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0066210
License Number StateMD

VIII. Authorized Official

Name: DR. ARYIAN LURECIA COOKE
Title or Position: CEO
Credential: M.D.
Phone: 240-252-2140