Provider Demographics
NPI:1467448548
Name:MCCLUSKEY, CORNELIA M (MD)
Entity Type:Individual
Prefix:
First Name:CORNELIA
Middle Name:M
Last Name:MCCLUSKEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4460 RED BANK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-2172
Mailing Address - Country:US
Mailing Address - Phone:513-321-4333
Mailing Address - Fax:513-232-0100
Practice Address - Street 1:4460 RED BANK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-2172
Practice Address - Country:US
Practice Address - Phone:513-321-4333
Practice Address - Fax:513-232-0100
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH858832085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2603516Medicaid
KY64123300Medicaid
OHH115480Medicare PIN
KY0503008Medicare PIN
OHI33011Medicare UPIN