Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | D36081 | MD |
N | 208600000X | Surgeon | D36081 | MD |
Y | 2086S0102X | Surgical Critical Care | MD17936 | DC |
NPI | 1285673079 |
---|---|
Provider Name | Edward Eugene Cornwell III |
First Address | Washington, DC 20060-0001 |
Second Address | Washington, DC 20060-0005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 02/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
039793200 | (05) | DC |
347821100 | (05) | MD |
E14907 | (02) | MD |