Provider Demographics
NPI:1740384379
Name:DE CHOLNOKY, CORINNE E (MD)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:E
Last Name:DE CHOLNOKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 W BROAD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3661
Mailing Address - Country:US
Mailing Address - Phone:203-325-9710
Mailing Address - Fax:203-325-0176
Practice Address - Street 1:166 W BROAD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3661
Practice Address - Country:US
Practice Address - Phone:203-325-9710
Practice Address - Fax:203-325-0176
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT025249207V00000X
VA0101032332207V00000X
MDD0025131207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT160000738Medicaid
CT025249OtherCONNECTICARE
CT061325219OtherUNITED HEALTHCARE
CT061325219OtherPHCS INSURANCE
CT2V5971OtherHEALTHNET
CT061325219OtherCIGNA
CT2080384OtherAETNA INSURANCE
CTZS008OtherOXFORD
CT010025249CT01OtherANTHEM BLUE CROSSBLUE SHI
CT061325219OtherGREAT WEST INSURANCE
CT061325219OtherGREAT WEST INSURANCE
CTZS008OtherOXFORD