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General NPI Number Information
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NPI Number | 1184382525
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Entity Type | Organization
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Legal Business Name | CORNER PEDIATRICS, PSC
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Dates
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Enumeration Date | 12/02/2021
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Last Update Date | 12/02/2021
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Provider Practice Location Address
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Address Line | 2505 LARKIN RD STE 103
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City | LEXINGTON
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State | KY
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Zip | 40503-3256
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Country | US
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Telephone | 859-600-1999
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Fax | 859-600-1998
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Provider Business Mailing Address
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Address Line | 2505 LARKIN RD STE 103
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City | LEXINGTON
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State | KY
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Zip | 40503-3256
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Country | US
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Telephone | 859-600-1999
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Fax | 859-600-1998
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SANDRA GREEN
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Credential | MD
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Telephone | 859-600-1999
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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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