Provider Demographics
NPI:1124064274
Name:CORNETT, EDWARD (DO)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:CORNETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:EDWARD
Other - Middle Name:
Other - Last Name:CORNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:21055 SHELBURNE RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1945
Mailing Address - Country:US
Mailing Address - Phone:216-224-1841
Mailing Address - Fax:
Practice Address - Street 1:3690 ORANGE PL STE 150
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4476
Practice Address - Country:US
Practice Address - Phone:216-839-0933
Practice Address - Fax:216-839-0934
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.004576208D00000X
OH34004576207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1124064274Medicaid