Healthcare Provider Details

I. General information

NPI: 1518073162
Provider Name (Legal Business Name): CORNEA CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 TRAPELO RD SUITE 184
WALTHAM MA
02451-7333
US

IV. Provider business mailing address

1601 TRAPELO RD SUITE 184
WALTHAM MA
02451-7333
US

V. Phone/Fax

Practice location:
  • Phone: 781-890-7797
  • Fax: 781-890-2507
Mailing address:
  • Phone: 781-890-7797
  • Fax: 781-890-2507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number72615
License Number StateMA

VIII. Authorized Official

Name: JOHATHAN H TALEMO
Title or Position: DIRECTOR
Credential: MD
Phone: 781-890-7797