MEDICARE: CORNELL ORTHOTICS AND PROSTHETICS, INC

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	335E00000X	Prosthetic/Orthotic Supplier		MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	801259	OTHER	MA	TUFTS MEDICARE PREFERRED

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	700854	OTHER	MA	HARVARD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	801259	OTHER	MA	TUFTS
5	8853	OTHER	MA	NEIGHBORHOOD HEALTH PLAN
6	355654	OTHER	MA	BCBS

General Provider Information

NPI Number	:	1366444739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNELL ORTHOTICS AND PROSTHETICS, INC

Provider Business Mailing Address
First Line	:	100 CUMMINGS CTR
Second Line	:	SUITE 207H
City	:	BEVERLY
State	:	MA
Zip	:	01915-6115
Country	:	US
Telephone Number	:	978-922-2866
Fax Number	:	978-922-0277

Provider Business Practice Location Address
First Line	:	100 CUMMINGS CTR
Second Line	:	SUITE 207H
City	:	BEVERLY
State	:	MA
Zip	:	01915-6115
Country	:	US
Telephone Number	:	978-922-2866
Fax Number	:	978-922-0277

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KEITH DONALD CORNELL
Credential	:	C.P.
Telephone Number	:	978-922-2866

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	01/30/2023

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Directions to “CORNELL ORTHOTICS AND PROSTHETICS, INC ” Practice Location

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