Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 249817 | NY |
N | 2080P0214X | Pediatric Pulmonologist | 15287 | NH |
Y | 2080P0214X | Pediatric Pulmonologist | 161586 | OR |
NPI | 1164580486 |
---|---|
Provider Name | Dr. Alexandra Gately Cornell |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239-3011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 15/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32000767 | (05) | NH |