Provider Demographics
NPI:1891933131
Name:CORNISH, EBONI NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:EBONI
Middle Name:NICOLE
Last Name:CORNISH
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 1:3391 VINELAND PLACE
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-1860
Mailing Address - Country:US
Mailing Address - Phone:401-559-4382
Mailing Address - Fax:
Practice Address - Street 1:1860 TOWN CENTER DRIVE
Practice Address - Street 2:260
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-1928
Practice Address - Country:US
Practice Address - Phone:703-709-1119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-24
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital