Provider Demographics
NPI:1750600623
Name:CORNERSTONE OB-GYN PA
Entity type:Organization
Organization Name:CORNERSTONE OB-GYN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-341-8001
Mailing Address - Street 1:16040 PARK VALLEY DRIVE
Mailing Address - Street 2:SUITE 222
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681
Mailing Address - Country:US
Mailing Address - Phone:512-341-8001
Mailing Address - Fax:512-341-8011
Practice Address - Street 1:16040 PARK VALLEY DRIVE
Practice Address - Street 2:SUITE 222
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681
Practice Address - Country:US
Practice Address - Phone:512-341-8001
Practice Address - Fax:512-341-8011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7423207V00000X
TXM8601207V00000X
TXH7068207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty