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Individual

KENNETH ROBERT COOKE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
CRB1 RM 207, 1650 ORLEANS STREET,, BALTIMORE, MD 21287-0001
(443) 287-2949
(410) 502-7223
Mailing address
6201 GREENLEIGH AVE, BALTIMORE, MD 21220-2004

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
4301074004
MI
2080P0207X
Pediatric Hematology & Oncology Physician
35090984
OH
2080P0207X
Pediatric Hematology & Oncology Physician
4301074004
MI
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
D76204
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000233275
UNISON
OH
01
000000558054
ANTHEM
OH
05
2146663
OH
05
4173898
MI
01
440046
WELLCARE
OH
01
5752459
AETNA
OH
01
753959
BUCKEYE
OH
05
932856559A
GA
Enumeration date
08/08/2006
Last updated
04/04/2023
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