Provider Demographics
NPI:1407359656
Name:CORNER, REGINALD A
Entity Type:Individual
Prefix:
First Name:REGINALD
Middle Name:A
Last Name:CORNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 EASTLAND RD
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-1217
Mailing Address - Country:US
Mailing Address - Phone:440-234-2006
Mailing Address - Fax:
Practice Address - Street 1:401 TUSCARAWAS ST W STE 501
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702
Practice Address - Country:US
Practice Address - Phone:440-260-8300
Practice Address - Fax:440-260-8575
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator