Provider Demographics
NPI:1386713063
Name:CORNWELL, STEPHEN L (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:CORNWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4401 FORD AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1473
Mailing Address - Country:US
Mailing Address - Phone:703-379-8879
Mailing Address - Fax:703-998-6821
Practice Address - Street 1:4401 FORD AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1473
Practice Address - Country:US
Practice Address - Phone:703-379-8879
Practice Address - Fax:703-998-6821
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043478207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080103530OtherRAILROAD MEDICARE
544640N07Medicare PIN
E13434Medicare UPIN