Provider Demographics
NPI:1912963281
Name:SCANNELL, CORNELIUS HUGH (MD)
Entity Type:Individual
Prefix:
First Name:CORNELIUS
Middle Name:HUGH
Last Name:SCANNELL
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 1:1402 NE 26TH ST
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1322
Mailing Address - Country:US
Mailing Address - Phone:954-749-1616
Mailing Address - Fax:954-749-1639
Practice Address - Street 1:1402 NE 26TH ST
Practice Address - Street 2:MEDICAL MULTI SPECIALTY GRP
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1322
Practice Address - Country:US
Practice Address - Phone:954-749-1616
Practice Address - Fax:954-749-1639
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90980207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL920512385813Medicaid
03494ZMedicare ID - Type Unspecified
FL920512385813Medicaid