Provider Demographics
NPI:1124087572
Name:COOK, ANNE MARIE (RPAC)
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:MARIE
Last Name:COOK
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:MS
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:GRAUSGRUBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPAC
Mailing Address - Street 1:346 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2580
Mailing Address - Country:US
Mailing Address - Phone:607-729-8156
Mailing Address - Fax:607-729-2209
Practice Address - Street 1:33 MITCHELL AVE
Practice Address - Street 2:SUITE G50
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-1674
Practice Address - Country:US
Practice Address - Phone:607-771-2220
Practice Address - Fax:607-771-2225
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051704363A00000X
NY009125-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02368078Medicaid
PAGU039978OtherMEDICARE GROUP
PAP00147128OtherRR MEDICARE PIN
PAGU039978OtherMEDICARE GROUP
NY02368078Medicaid