1093162190 NPI number — MRS. ROBIN SUMMERS CORNISH CPHT

Table of content: MRS. ROBIN SUMMERS CORNISH CPHT (NPI 1093162190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093162190 NPI number — MRS. ROBIN SUMMERS CORNISH CPHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORNISH
Provider First Name:
ROBIN
Provider Middle Name:
SUMMERS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CPHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARRITY
Provider Other First Name:
ROBIN
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CPHT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093162190
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1427 QUICK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKVIEW
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25071-7916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-341-0257
Provider Business Mailing Address Fax Number:
304-341-0557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 MORRIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25301-1326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-341-0257
Provider Business Practice Location Address Fax Number:
304-341-0557
Provider Enumeration Date:
05/18/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183700000X , with the licence number:  PT0007097 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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