MEDICARE: RICHARD EUGENE COOK JR. M.D.

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	207R00000X	Internal Medicine Physician	D0063483	MD

General Provider Information

NPI Number	:	1811970056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD EUGENE COOK JR. M.D.

Provider Business Mailing Address
First Line	:	PO BOX 215
Second Line	:
City	:	BRYANTOWN
State	:	MD
Zip	:	20617-0215
Country	:	US
Telephone Number	:	301-472-4290
Fax Number	:	240-607-3609

Provider Business Practice Location Address
First Line	:	3450 OLD WASHINGTON RD
Second Line	:	SUITE 103
City	:	WALDORF
State	:	MD
Zip	:	20602-3248
Country	:	US
Telephone Number	:	301-472-4290
Fax Number	:	240-607-3609

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	07/13/2024

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