Healthcare Provider Details

I. General information

NPI: 1023469376
Provider Name (Legal Business Name): JODI P COOK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE FL 3
RALEIGH NC
27610-1231
US

IV. Provider business mailing address

3000 NEW BERN AVE FL 3
RALEIGH NC
27610-1231
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-7828
  • Fax: 919-350-8874
Mailing address:
  • Phone: 304-923-2889
  • Fax: 919-350-8874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28282
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberRTL
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number58797
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: