Provider Demographics
NPI:1790792638
Name:CORNELL UNIVERSITY MEDICAL COLLEGE
Entity Type:Organization
Organization Name:CORNELL UNIVERSITY MEDICAL COLLEGE
Other - Org Name:CORNELL PLASTIC SURGERY
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER FOR PO
Authorized Official - Prefix:
Authorized Official - First Name:DARRACOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:212-746-6464
Mailing Address - Street 1:525 E 68TH ST
Mailing Address - Street 2:BOX 129
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4870
Mailing Address - Country:US
Mailing Address - Phone:212-746-5593
Mailing Address - Fax:
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:SUITE M014
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4870
Practice Address - Country:US
Practice Address - Phone:212-746-5593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty