Healthcare Provider Details

I. General information

NPI: 1902844186
Provider Name (Legal Business Name): MATTHEW D COOK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S CEDAR CREST BLVD
ALLENTOWN PA
18103
US

IV. Provider business mailing address

PO BOX 1754
ALLENTOWN PA
18105-1754
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-8111
  • Fax:
Mailing address:
  • Phone: 610-798-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License NumberOS014086
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS014086
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: