Healthcare Provider Details

I. General information

NPI: 1619134814
Provider Name (Legal Business Name): IOAN CORNELIU CUCORANU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 W TWINCOURT TRL UNIT 604A
ST AUGUSTINE FL
32095-8805
US

IV. Provider business mailing address

7929 STRATFORD CHASE LN
JACKSONVILLE FL
32256-3445
US

V. Phone/Fax

Practice location:
  • Phone: 904-551-9949
  • Fax:
Mailing address:
  • Phone: 904-551-9949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberME119404
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number078009
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: