MEDICARE: DR. RONALD E. CORDELL M.D.

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
1	2085R0202X	Diagnostic Radiology Physician	12509	WV
2	2085R0204X	Vascular & Interventional Radiology Physician	12509	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	A72575	OTHER	WV	BRICKSTREET INSURANCE
3	0130753	OTHER	WV	UMWA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	14193	OTHER	WV	CARELINK & CARELINK PEIA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346244944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD E. CORDELL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 11137
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25339-1137
Country	:	US
Telephone Number	:	304-344-3457
Fax Number	:	304-344-3480

Provider Business Practice Location Address
First Line	:	1120 KANAWHA BLVD E
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25301-2400
Country	:	US
Telephone Number	:	304-344-3457
Fax Number	:	304-344-3480

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	02/25/2008

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Directions to “ DR. RONALD E. CORDELL M.D.” Practice Location

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