Healthcare Provider Details

I. General information

NPI: 1760404180
Provider Name (Legal Business Name): DEBORAH LYNN COOK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

111 COLCHESTER AVE ACC - EP2
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-5186
  • Fax: 802-847-4155
Mailing address:
  • Phone: 802-847-5186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number042-0009138
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: