Provider Demographics
NPI:1184715526
Name:CORDINGLEY, GARY EDWARD (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:EDWARD
Last Name:CORDINGLEY
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 1:75 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701
Mailing Address - Country:US
Mailing Address - Phone:740-594-8147
Mailing Address - Fax:740-594-8148
Practice Address - Street 1:75 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 360
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701
Practice Address - Country:US
Practice Address - Phone:740-594-8147
Practice Address - Fax:740-594-8148
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0487572084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH31106661900OtherBWC
OH0512609Medicaid
P00173094OtherRAILROAD CARRIER MEDICARE
C00526571Medicare ID - Type Unspecified
OH0512609Medicaid