Individual
SAMUEL ANNIBALE COOK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4701 MELBOURNE PL, COLLEGE PARK, MD 20740-2540
(301) 345-4400
(301) 345-4200
Mailing address
6737 OLD WATERLOO RD APT 114, ELKRIDGE, MD 21075-7114
(503) 758-4931
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0008045
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1169827
NCCPA
—
01
—
C0008045
MARYLAND BOARD OF PHYSICIANS
MD
Enumeration date
07/19/2021
Last updated
07/19/2021
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