Provider Demographics
NPI:1790778595
Name:CORL, JOHN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:CORL
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 1:7545 BEECHMONT AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-4205
Mailing Address - Country:US
Mailing Address - Phone:513-206-1320
Mailing Address - Fax:513-232-8483
Practice Address - Street 1:7545 BEECHMONT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-4222
Practice Address - Country:US
Practice Address - Phone:513-206-1320
Practice Address - Fax:513-232-8483
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075272207RC0000X
KY35726207RC0000X
OH35.075272207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200425410Medicaid
KY64068018Medicaid
OH000000526402OtherANTHEM
OH2504699OtherUNITED
OHCO4211061Medicare PIN
OH2504699OtherUNITED
KYH80142Medicare UPIN