Provider Demographics
NPI:1861671828
Name:C E CORNACCHIONE LLC
Entity Type:Organization
Organization Name:C E CORNACCHIONE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CORNACCHIONE
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:330-733-4031
Mailing Address - Street 1:717 CANTON RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-2606
Mailing Address - Country:US
Mailing Address - Phone:330-733-4031
Mailing Address - Fax:330-733-7887
Practice Address - Street 1:717 CANTON RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-2606
Practice Address - Country:US
Practice Address - Phone:330-733-4031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP07904207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000344569OtherANTHEM
OH278809918001OtherMEDICAL MUTUAL
OH2505300Medicaid
OH000000344569OtherANTHEM