Provider Demographics
NPI:1376545327
Name:CORNELL, RICHARD SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SCOTT
Last Name:CORNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 DUTCHMANS PKWY
Mailing Address - Street 2:STE 250
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3340
Mailing Address - Country:US
Mailing Address - Phone:502-587-9660
Mailing Address - Fax:502-540-5615
Practice Address - Street 1:6400 DUTCHMANS PKWY
Practice Address - Street 2:STE 250
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3340
Practice Address - Country:US
Practice Address - Phone:502-587-9660
Practice Address - Fax:502-540-5615
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33948207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1092925OtherPASSPORT
KY64339484Medicaid
KYANTHEMOther000000064450
KY1092925OtherPASSPORT
KY64339484Medicaid
IN124270LMedicare ID - Type Unspecified
INP00190577Medicare ID - Type UnspecifiedPALMETTO GBA