Provider Demographics
NPI:1265469472
Name:CORNWELL, CREEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:CREEL
Middle Name:S
Last Name:CORNWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:120 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9012
Mailing Address - Country:US
Mailing Address - Phone:304-624-7200
Mailing Address - Fax:304-624-0026
Practice Address - Street 1:120 MEDICAL PARK DR
Practice Address - Street 2:SUITE 300
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9012
Practice Address - Country:US
Practice Address - Phone:304-624-7200
Practice Address - Fax:304-423-5208
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2013-03-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV09342207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0087204000Medicaid
WV0087204000Medicaid
WV381134Medicare ID - Type Unspecified