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NPI Code Detail

MEDICARE: GEORGE B CORN PLLC

MEDICARE: GEORGE B CORN PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician20462WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100171194OTHERWVBCBS

General Provider Information

NPI Number : 1083734941
Entity Type Code : Organization
Provider Name (Legal Business Name) : GEORGE B CORN PLLC
Provider Business Mailing Address
First Line : 2410 JEFFERSON AVE
Second Line :
City : PT PLEASANT
State : WV
Zip : 25550-1528
Country : US
Telephone Number : 304-675-7100
Fax Number : 304-675-7102
Provider Business Practice Location Address
First Line : 2410 JEFFERSON AVE
Second Line :
City : PT PLEASANT
State : WV
Zip : 25550-1528
Country : US
Telephone Number : 304-675-7100
Fax Number : 304-675-7102
Authorized Official
Title or Position : MD
Name : GEORGE B CORN
Credential : MD
Telephone Number : 304-675-7100
Provider Enumeration Date : 04/01/2007
Last Update Date : 08/22/2020

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