Cornell Medical LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

CORNELL MEDICAL LLC

Practice address

200 Unicorn Park Dr Ste 302
Woburn, MA 01801-3342

Phone

(781) 756-2308

Fax

(781) 756-4798

NPI assigned

Sep 24, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kelley Michelle Cornell, MD

Title

Owner

Phone

(781) 883-7993

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600905600000",
    "number": "1689281610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80556",
            "city": "STONEHAM",
            "state": "MA",
            "postal_code": "021800006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 UNICORN PARK DR STE 302",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018013342",
            "telephone_number": "781-756-2308",
            "fax_number": "781-756-4798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNELL MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-24",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A",
        "authorized_official_last_name": "CORNELL",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "781-883-7993",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A23738",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren Adamek Cook, PH.D
• Deborah A Cooper, O.T.
• Jennifer M Cooper
• Anya Elizabeth Cootey, BASW
• Shannon Cormier
• Kelley M Cornell, M.D., FACS
• Cornerstone Primary and Senior Care LLC
• Brielle Paige Correia
• Brendan Joseph Corsino
• Lisa Corti, DVM

• Surgery Physician in Woburn, MA
• Providers in Woburn, MA by specialty
• Surgery Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.