Provider Demographics
NPI:1790858637
Name:CORNELIUS, CHRIS ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:ROBERT
Last Name:CORNELIUS
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 1:19 SPELLMAN TER
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4123
Mailing Address - Country:US
Mailing Address - Phone:802-775-1800
Mailing Address - Fax:802-775-1820
Practice Address - Street 1:215 STRATTON RD
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4621
Practice Address - Country:US
Practice Address - Phone:802-773-3386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76538207Q00000X
VT042-0010037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT08497OtherMVP
VT1009665Medicaid
VTP00168543OtherMEDICARE RAILROAD
VT3203553OtherCIGNA
VT59378OtherBCBS
VT08497OtherMVP
VTP00168543OtherMEDICARE RAILROAD