Provider Demographics
NPI:1568869048
Name:CORNERSTONE GERIATRIC CARE, PC
Entity Type:Organization
Organization Name:CORNERSTONE GERIATRIC CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:D
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-535-5887
Mailing Address - Street 1:21846 N 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-2003
Mailing Address - Country:US
Mailing Address - Phone:623-535-5887
Mailing Address - Fax:602-429-8112
Practice Address - Street 1:6740 W DEER VALLEY RD
Practice Address - Street 2:PMB 304
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-5953
Practice Address - Country:US
Practice Address - Phone:623-535-5887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-26
Last Update Date:2014-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46497207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty