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General NPI Number Information
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NPI Number | 1033254222
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Entity Type | Organization
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Legal Business Name | CORNERSTONE PEDIATRICS LLC
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 12/02/2020
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Provider Practice Location Address
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Address Line | 3333 W TECH RD STE 220
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City | MIAMISBURG
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State | OH
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Zip | 45342-0956
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Country | US
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Telephone | 937-885-4475
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Fax | 937-885-3670
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Provider Business Mailing Address
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Address Line | 76 REMICK BLVD
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City | SPRINGBORO
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State | OH
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Zip | 45066
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Country | US
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Telephone | 937-885-4475
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Fax | 937-885-3670
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | GREGORY EBERHART
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Credential |
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Telephone | 937-885-4475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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