MEDICARE: PETER J CORNELL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	G55677	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548370794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER J CORNELL MD

Provider Business Mailing Address
First Line	:	450 N BEDFORD DRIVE
Second Line	:	SUITE 101
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4324
Country	:	US
Telephone Number	:	310-274-9205
Fax Number	:	310-274-7229

Provider Business Practice Location Address
First Line	:	450 N BEDFORD DRIVE
Second Line	:	SUITE 101
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4324
Country	:	US
Telephone Number	:	310-274-9205
Fax Number	:	310-274-7229

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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Practice Fax: 310-274-7229

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