Provider Demographics
NPI:1225018864
Name:CORNELIUS, REBECCA S (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:CORNELIUS
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:PO BOX 636256 CENTRAL CREDENTIALING
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-245-3107
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:350 THOMAS MORE PKWY
Practice Address - Street 2:SUITE 160
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5465
Practice Address - Country:US
Practice Address - Phone:513-221-1100
Practice Address - Fax:513-569-5297
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0598242085R0202X
KY353812085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH138300001OtherCARESOURCE
KY64864200Medicaid
OH0786645Medicaid
OH300033820OtherRAILROAD MEDICARE
OH655253OtherAETNA
OH1620959OtherUNITED HEALTHCARE
OH000000014204OtherANTHEM
IN200039490AMedicaid
OH138300001OtherCARESOURCE
OHE78457Medicare UPIN