Provider Demographics
NPI:1144415548
Name:YETMAN, CORNELIUS (DO)
Entity Type:Individual
Prefix:
First Name:CORNELIUS
Middle Name:
Last Name:YETMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 GLEN COVE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-4235
Mailing Address - Country:US
Mailing Address - Phone:207-593-5800
Mailing Address - Fax:207-593-5332
Practice Address - Street 1:4 GLEN COVE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4235
Practice Address - Country:US
Practice Address - Phone:207-593-5800
Practice Address - Fax:207-593-5332
Is Sole Proprietor?:No
Enumeration Date:2007-09-09
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228980207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine