Provider Demographics
NPI:1710974027
Name:CORDOVA, JOSEPH R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:R
Last Name:CORDOVA
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 1:1254 YOUNGSTOWN WARREN RD
Mailing Address - Street 2:STE 3A
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-4612
Mailing Address - Country:US
Mailing Address - Phone:330-652-3000
Mailing Address - Fax:330-652-3008
Practice Address - Street 1:1254 YOUNGSTOWN WARREN RD
Practice Address - Street 2:STE 3A
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-4612
Practice Address - Country:US
Practice Address - Phone:330-652-3000
Practice Address - Fax:330-652-3008
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072593C207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00080212OtherRAILROAD MEDICARE
OH2141444Medicaid
OHCO0847326OtherMEDICARE ID
OHG73060Medicare UPIN
OH0847326Medicare PIN