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General NPI Number Information
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NPI Number | 1689813404
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Entity Type | Organization
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Legal Business Name | CONSOLAB INC
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Dates
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Enumeration Date | 02/18/2009
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Last Update Date | 06/19/2009
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Provider Practice Location Address
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Address Line | 1000 N WEST ST
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City | WILMINGTON
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State | DE
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Zip | 19801-1050
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Country | US
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Telephone | 818-915-4014
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 N WEST ST
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City | WILMINGTON
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State | DE
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Zip | 19801-1050
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LAURIE P COOKE
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Credential | MD
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Telephone | 818-915-4014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | C10005054
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License Number State | DE
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