Active NPI
William J Cornetta III, M.D.
- Anatomic Pathology & Clinical Pathology Physician
- Beverly, MA
National Provider Identifier
1174596761
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 34141
- Practice address
- 85 Herrick St
Beverly Hospital
Beverly, MA 01915-1776 - Phone
- (978) 922-3000
- NPI assigned
- Feb 13, 2006
- Last updated
- Dec 11, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 34141 | MA | Primary |
Addresses
Primary practice location
85 Herrick St
Beverly Hospital
Beverly, MA 01915-1776
Mailing address
PO Box 414230
Boston, MA 02241-4230
Phone (603) 893-9784
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6167942 | Medicaid | MA | |
| D08052 | Other | MA | BCBS MA |
| 710537 | Other | MA | TUFTS HEALTH PLAN |
| DM0438 | Other | MA | HARVARD PILGRIM |
| 220020523 | Other | MA | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34141 | MA | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260489600000",
"number": "1174596761",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 414230",
"city": "BOSTON",
"state": "MA",
"postal_code": "022414230",
"telephone_number": "603-893-9784",
"fax_number": "603-893-8886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "85 HERRICK ST",
"address_2": "BEVERLY HOSPITAL",
"city": "BEVERLY",
"state": "MA",
"postal_code": "019151776",
"telephone_number": "978-922-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORNETTA",
"first_name": "WILLIAM",
"middle_name": "J",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-13",
"last_updated": "2009-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "MA",
"license": "34141",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6167942",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MA",
"identifier": "D08052",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HEALTH PLAN",
"identifier": "710537",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM",
"identifier": "DM0438",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "220020523",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Beverly, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.