Provider Demographics
NPI:1699735654
Name:COOK, CHARLES ALVIN (M D)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ALVIN
Last Name:COOK
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3372 SIX FORKS RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7233
Mailing Address - Country:US
Mailing Address - Phone:919-783-0200
Mailing Address - Fax:919-783-0203
Practice Address - Street 1:3372 SIX FORKS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7233
Practice Address - Country:US
Practice Address - Phone:919-783-0200
Practice Address - Fax:919-783-0203
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24639207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890226FMedicaid
NC0226FOtherBCBS
NC2309909Medicare PIN
NC0226FOtherBCBS