Provider Demographics
NPI:1023007259
Name:CORNWELL, JOHN M (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:CORNWELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:460 TOTTEN POND RD
Mailing Address - Street 2:C/O MZI
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1991
Mailing Address - Country:US
Mailing Address - Phone:781-890-9933
Mailing Address - Fax:781-890-9930
Practice Address - Street 1:88 WASHINGTON ST
Practice Address - Street 2:ATTN EMERGENCY DEPT
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2465
Practice Address - Country:US
Practice Address - Phone:508-828-7108
Practice Address - Fax:508-828-7158
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2010-02-22
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Provider Licenses
StateLicense IDTaxonomies
MA70426207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ10558OtherBCBS
MA410296OtherTUFTS
MA437057OtherHPHC
MA0121657Medicaid
C70028Medicare UPIN
MA0121657Medicaid