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General NPI Number Information
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NPI Number | 1164506762
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Entity Type | Organization
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Legal Business Name | DIANE M. CORNICELLI, M.D. INC,
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 36001 EUCLID AVE SUITE C-19
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City | WILLOUGHBY
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State | OH
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Zip | 44094-4643
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Country | US
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Telephone | 216-374-9664
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 221427
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City | BEACHWOOD
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State | OH
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Zip | 44122-0999
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Country | US
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Telephone | 216-374-9664
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DIANE CORNICELLI
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Credential | M.D.
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Telephone | 216-374-9664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35056746
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License Number State | OH
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