Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD422463 | PA |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 35.092493 | OH |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 35.092493 | OH |
NPI | 1376633826 |
---|---|
Provider Name | Dr. Roger Cornwall |
First Address | Cincinnati, OH 45229-3026 |
Second Address | Cincinnati, OH 45229-3026 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 02/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100849367 | (05) | PA |
H70327 | (02) | PA |