Provider Demographics
NPI:1164428090
Name:CORDASCO, EDWARD M (DO)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:M
Last Name:CORDASCO
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 1:3545 OLENTANGY RIVER RD
Mailing Address - Street 2:STE 201
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3907
Mailing Address - Country:US
Mailing Address - Phone:614-267-8585
Mailing Address - Fax:614-267-9793
Practice Address - Street 1:3545 OLENTANGY RIVER RD
Practice Address - Street 2:STE 201
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3907
Practice Address - Country:US
Practice Address - Phone:614-267-8585
Practice Address - Fax:614-267-9793
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-3896-C174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0628054-009OtherCIGNA
OH3111906783215OtherBCBS
OH4880094OtherUHC
OH0669021Medicaid
OH3111906783215OtherBCBS
OHC03484Medicare UPIN