MEDICARE: DR. SUNDAR JOHN COOK PSY.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	103G00000X	Clinical Neuropsychologist	0810003809	VA
2	103TC0700X	Clinical Psychologist	0810003809	VA

General Provider Information

NPI Number	:	1881898609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUNDAR JOHN COOK PSY.D.

Provider Business Mailing Address
First Line	:	411 1/2 N WASHINGTON ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2311
Country	:	US
Telephone Number	:	540-931-5238
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 1/2 N WASHINGTON ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2311
Country	:	US
Telephone Number	:	540-931-5238
Fax Number	:

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

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	05/06/2020

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