Provider Demographics
NPI:1710075668
Name:CORNFIELD, DENNIS BOREK (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:BOREK
Last Name:CORNFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 BRIDLE RD.
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-2001
Mailing Address - Country:US
Mailing Address - Phone:215-572-5916
Mailing Address - Fax:
Practice Address - Street 1:509 BRIDLE RD.
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-2001
Practice Address - Country:US
Practice Address - Phone:215-572-5916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD011141E207RH0003X, 207ZH0000X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD011141EOtherSTATE LICENSE NUMBER
013903Medicare ID - Type Unspecified
I54476Medicare UPIN