Organization
DIANE M. CORNICELLI, M.D. INC,
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIANE CORNICELLI M.D. (PRESIDENT)
(216) 374-9664
Entity
Organization
Contact information
Practice address
36001 EUCLID AVE, SUITE C-19, WILLOUGHBY, OH 44094-4643
(216) 374-9664
Mailing address
PO BOX 221427, BEACHWOOD, OH 44122-0999
(216) 374-9664
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35056746
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0784414
—
OH
Enumeration date
10/24/2006
Last updated
08/22/2020
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