Provider Demographics
NPI:1417169848
Name:CORNATZER, PAULINA MONIKA (MD)
Entity Type:Individual
Prefix:
First Name:PAULINA
Middle Name:MONIKA
Last Name:CORNATZER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAULINA
Other - Middle Name:MONIKA
Other - Last Name:MOCHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:817 PRINCETON AVE SW
Mailing Address - Street 2:POB II, STE 300
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211
Mailing Address - Country:US
Mailing Address - Phone:205-783-7970
Mailing Address - Fax:205-783-7695
Practice Address - Street 1:817 PRINCETON AVE SW
Practice Address - Street 2:POB II, STE 300
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211
Practice Address - Country:US
Practice Address - Phone:205-783-7970
Practice Address - Fax:205-783-7695
Is Sole Proprietor?:No
Enumeration Date:2007-05-06
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AL29943207R00000X
TNMD48495207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I115451OtherMEDICARE
MS04655362Medicaid
AL051120188OtherBCBS
ALZ30031OtherVIVA
AL131753Medicaid
AL051120187OtherBCBS
AL131752Medicaid
AL051120189OtherBCBS
AL131747Medicaid