Healthcare Provider Details

I. General information

NPI: 1174629695
Provider Name (Legal Business Name): LYDIA ALEXANDER-COOK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYDIA A. COOK

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SEVERANCE CIR
CLEVELAND HTS OH
44118-1533
US

IV. Provider business mailing address

1001 LAKESIDE AVE E #1200
CLEVELAND OH
44114-1158
US

V. Phone/Fax

Practice location:
  • Phone: 216-524-7377
  • Fax: 216-297-2562
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-053698
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: