MEDICARE: JEFFRY A COOKE PA-C

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	363A00000X	Physician Assistant	MA051197	PA

General Provider Information

NPI Number	:	1639101389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFRY A COOKE PA-C

Provider Business Mailing Address
First Line	:	5275 LINCOLN HWY
Second Line	:
City	:	GAP
State	:	PA
Zip	:	17527-9427
Country	:	US
Telephone Number	:	717-442-8111
Fax Number	:	717-442-8981

Provider Business Practice Location Address
First Line	:	5275 LINCOLN HWY
Second Line	:
City	:	GAP
State	:	PA
Zip	:	17527-9427
Country	:	US
Telephone Number	:	717-442-8111
Fax Number	:	717-442-8981

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	10/08/2007

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