MEDICARE: LEWIS A. COOK 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	207Q00000X	Family Medicine Physician	9864	WV

General Provider Information

NPI Number	:	1952311722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEWIS A. COOK M.D.

Provider Business Mailing Address
First Line	:	5495 MAPLE LN
Second Line	:
City	:	FAYETTEVILLE
State	:	WV
Zip	:	25840-6872
Country	:	US
Telephone Number	:	304-574-1888
Fax Number	:	304-574-1891

Provider Business Practice Location Address
First Line	:	5495 MAPLE LANE
Second Line	:
City	:	FAYETTEVILLE
State	:	WV
Zip	:	25840-1413
Country	:	US
Telephone Number	:	304-574-1888
Fax Number	:	304-574-1891

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	10/14/2013

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