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General NPI Number Information
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NPI Number | 1124482773
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Entity Type | Organization
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Legal Business Name | CORNERSTONE MEDICAL SERVICES PC
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Dates
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Enumeration Date | 04/11/2016
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Last Update Date | 12/05/2016
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Provider Practice Location Address
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Address Line | 2337 KEW GARDENS DR
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City | WOODBRIDGE
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State | VA
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Zip | 22191-6577
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Country | US
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Telephone | 646-593-6787
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4212
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City | WOODBRIDGE
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State | VA
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Zip | 22194-4212
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Country | US
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Telephone | 646-593-6787
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. LILY O OTOLORIN
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Credential | M.D.,MBA,FACP
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Telephone | 646-593-6787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | 0101250835
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License Number State | VA
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