Provider Demographics
NPI:1194834275
Name:CORTINA, JOHN JEFFREY (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JEFFREY
Last Name:CORTINA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:JEFFERY
Other - Last Name:CORTINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1021 W OAKLAND AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2192
Mailing Address - Country:US
Mailing Address - Phone:423-302-6565
Mailing Address - Fax:
Practice Address - Street 1:16000 JOHNSTON MEMORIAL DR STE 312D
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-7664
Practice Address - Country:US
Practice Address - Phone:276-258-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO2865207RP1001X
PA0S008622L207RP1001X
GA63410207RP1001X
KY03675207RP1001X
VA0102206432207RP1001X
NC200800053207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016237640014Medicaid
PA94946OtherGEISINGER
NC8901960OtherGROUP MEDICAID
NC1467405431OtherGROUP NPI
NC560989277OtherTAX ID
610283400OtherBLACK LUNG
PA00662229OtherBLUE SHIELD
NC5908296Medicaid
NC01960OtherGROUP BCBS
PA251424OtherUPMC
P00233040OtherMETRAHEALTH RAILROAD MEDI
NC0326OtherGROUP MEDICARE NUMBER
NC148V3OtherBCBS
NC5908296Medicaid
NC2021917Medicare PIN
NC0326OtherGROUP MEDICARE NUMBER