Healthcare Provider Details

I. General information

NPI: 1386508646
Provider Name (Legal Business Name): MARC CORNES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1453 E MAIN ST
COLUMBUS OH
43205-2152
US

IV. Provider business mailing address

296 CULLMAN RD
COLUMBUS OH
43207-3022
US

V. Phone/Fax

Practice location:
  • Phone: 614-671-2903
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.007028
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: