Provider Demographics
NPI:1669442901
Name:CORNFORD, MARCIA (MD, PHD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:CORNFORD
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21840 NORMANDIE AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2047
Mailing Address - Country:US
Mailing Address - Phone:310-222-2643
Mailing Address - Fax:310-222-5027
Practice Address - Street 1:21840 NORMANDIE AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2047
Practice Address - Country:US
Practice Address - Phone:310-222-2643
Practice Address - Fax:310-222-5027
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56070207ZN0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G560700Medicaid
CAWG56070DMedicare ID - Type UnspecifiedPPIN
CA00G560700Medicaid
CAWG56070EMedicare ID - Type UnspecifiedPPIN
CAWG56070CMedicare ID - Type UnspecifiedPPIN