MEDICARE: DR. DAN ROGER CORNELL 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	2085R0001X	Radiation Oncology Physician	D0039518	MD

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609857028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAN ROGER CORNELL M.D.

Provider Business Mailing Address
First Line	:	1802 OCEAN DR
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32963-2110
Country	:	US
Telephone Number	:	301-455-1090
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 5TH AVE
Second Line	:
City	:	MCKEESPORT
State	:	PA
Zip	:	15132-2422
Country	:	US
Telephone Number	:	412-664-2676
Fax Number	:

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

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	03/19/2019

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