Healthcare Provider Details

I. General information

NPI: 1841435302
Provider Name (Legal Business Name): ANDREW ALFRED CORNWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 SE VIEWMONT AVE
CORVALLIS OR
97333-1968
US

IV. Provider business mailing address

PO BOX 579
CORVALLIS OR
97339-0579
US

V. Phone/Fax

Practice location:
  • Phone: 541-766-3546
  • Fax: 541-766-6143
Mailing address:
  • Phone: 541-766-6835
  • Fax: 541-766-6186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD23625
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: