Provider Demographics
NPI:1164958849
Name:CORSELLO, JENALEE ANNE (MD)
Entity Type:Individual
Prefix:
First Name:JENALEE
Middle Name:ANNE
Last Name:CORSELLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 20TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25703-2071
Mailing Address - Country:US
Mailing Address - Phone:304-399-4121
Mailing Address - Fax:304-399-4127
Practice Address - Street 1:1115 20TH ST STE 101
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-2071
Practice Address - Country:US
Practice Address - Phone:304-399-4121
Practice Address - Fax:304-399-4127
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV32694208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery