Basic Information
| Provider Information | |||||||||
| NPI: | 1972693612 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOKE | ||||||||
| FirstName: | LAURIE | ||||||||
| MiddleName: | P. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 191 | ||||||||
| Address2: | PROVIDER ENROLLMENT DEPT | ||||||||
| City: | ROCKLAND | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197320191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026516212 | ||||||||
| FaxNumber: | 3026514945 | ||||||||
| Practice Location | |||||||||
| Address1: | NEMOURS PEDIATRICS JESSUP ST. | ||||||||
| Address2: | 1602 JESSUP STREET | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198024210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3025765050 | ||||||||
| FaxNumber: | 3025765065 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 09/12/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | C10005054 | DE | N | Allopathic & Osteopathic Physicians | Pediatrics | 208D00000X | C10005054 | DE | Y | Allopathic & Osteopathic Physicians | General Practice | 208M00000X | C10005054 | DE | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 5442001 | 05 | MD | MEDICAID | 001278T34 | 05 | DE | MEDICAID | 001682596 | 05 | PA | MEDICAID | 7495307 | 05 | NJ | MEDICAID |