Provider Demographics
NPI:1376705335
Name:STIVER, COREY A (MD)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:A
Last Name:STIVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:COREY
Other - Middle Name:A
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:700 CHILDRENS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2664
Mailing Address - Country:US
Mailing Address - Phone:614-722-2555
Mailing Address - Fax:614-722-2549
Practice Address - Street 1:700 CHILDRENS DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2664
Practice Address - Country:US
Practice Address - Phone:614-722-2555
Practice Address - Fax:614-722-2549
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0945252080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0079593Medicaid