Provider Demographics
NPI:1710095104
Name:MONTCLAIR RHEUMATOLOGY, PC
Entity Type:Organization
Organization Name:MONTCLAIR RHEUMATOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CORNELIUS
Authorized Official - Middle Name:B
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-591-2758
Mailing Address - Street 1:880 MONTCLAIR RD
Mailing Address - Street 2:SUITE 470
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-1972
Mailing Address - Country:US
Mailing Address - Phone:205-591-2758
Mailing Address - Fax:205-592-0318
Practice Address - Street 1:880 MONTCLAIR RD
Practice Address - Street 2:SUITE 470
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1972
Practice Address - Country:US
Practice Address - Phone:205-591-2758
Practice Address - Fax:205-592-0318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty