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General NPI Number Information
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NPI Number | 1720071095
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Entity Type | Individual
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Provider Name | TIMOTHY G COOK M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 79 NORTH ST
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City | GRANVILLE
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State | NY
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Zip | 12832-1137
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Country | US
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Telephone | 518-642-0612
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Fax | 518-642-0693
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Provider Business Mailing Address
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Address Line | 100 PARK STREET GLENS FALLS HOSPITAL - CREDENTIALING
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City | GLENS FALLS
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State | NY
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Zip | 12801-4413
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Country | US
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Telephone | 518-926-6992
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Fax | 802-775-3058
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 320347
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 042-0009268
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License Number State | VT
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