Healthcare Provider Details

I. General information

NPI: 1396791471
Provider Name (Legal Business Name): BETH COOK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SPRINGVIEW LANE
SUMMERVILLE SC
29485
US

IV. Provider business mailing address

75 SPRINGVIEW LN
SUMMERVILLE SC
29485-8154
US

V. Phone/Fax

Practice location:
  • Phone: 843-832-5096
  • Fax:
Mailing address:
  • Phone: 843-832-5096
  • Fax: 843-832-5115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number230725
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: