1104973270 NPI number — MARGIE CORNEY, MD PC

Table of content: (NPI 1104973270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104973270 NPI number — MARGIE CORNEY, MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARGIE CORNEY, MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104973270
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
817 GREENBRIER PKWY
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
CHESAPEAKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23320-3823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-673-3216
Provider Business Mailing Address Fax Number:
757-548-9581

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
817 GREENBRIER PKWY
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CHESAPEAKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23320-3823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-673-3216
Provider Business Practice Location Address Fax Number:
757-548-9581
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CORNEY
Authorized Official First Name:
MARGIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
757-548-1918

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  0101227544 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 0101035740 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 24103 . This is a "OPTIMA PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 317433 . This is a "ANTHEM PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 00620059 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 053055 . This is a "ANTHEM PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 34614 . This is a "OPTIMA PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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