Provider Demographics
NPI:1710932900
Name:CORNEY, ISAAC (MD)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:CORNEY
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 1:3038 OLIVE RD
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-2640
Mailing Address - Country:US
Mailing Address - Phone:937-208-7050
Mailing Address - Fax:937-208-7031
Practice Address - Street 1:3038 OLIVE RD
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-2640
Practice Address - Country:US
Practice Address - Phone:937-208-7050
Practice Address - Fax:937-208-7031
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.061672207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0853778Medicaid
OH4028263Medicare PIN
OH0853778Medicaid