MEDICARE: NATHAN PAUL COOK DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	2011-00110	NC

General Provider Information

NPI Number	:	1396918926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN PAUL COOK DO

Provider Business Mailing Address
First Line	:	5710 OLEANDER DR STE 207
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-4722
Country	:	US
Telephone Number	:	910-399-1954
Fax Number	:	910-388-2702

Provider Business Practice Location Address
First Line	:	5710 OLEANDER DR STE 207
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-4722
Country	:	US
Telephone Number	:	910-399-1954
Fax Number	:	910-388-2702

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2008
Last Update Date	:	02/02/2022

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