Provider Demographics
NPI:1619074408
Name:CORDERO, BRUNILDA (MD)
Entity Type:Individual
Prefix:
First Name:BRUNILDA
Middle Name:
Last Name:CORDERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ROBESON ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-5552
Mailing Address - Country:US
Mailing Address - Phone:910-615-1885
Mailing Address - Fax:910-321-6254
Practice Address - Street 1:101 ROBESON ST
Practice Address - Street 2:SUITE 410
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5552
Practice Address - Country:US
Practice Address - Phone:910-615-1885
Practice Address - Fax:910-321-6254
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC278762080P0204X
NC2005-011602080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I47181Medicare UPIN