Provider Demographics
NPI:1619134814
Name:CUCORANU, IOAN CORNELIU (MD)
Entity type:Individual
Prefix:DR
First Name:IOAN
Middle Name:CORNELIU
Last Name:CUCORANU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7929 STRATFORD CHASE LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-3445
Mailing Address - Country:US
Mailing Address - Phone:904-551-9949
Mailing Address - Fax:
Practice Address - Street 1:559 W TWINCOURT TRL UNIT 604A
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-8805
Practice Address - Country:US
Practice Address - Phone:904-551-9949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119404207ZP0105X
GA078009207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011137000Medicaid
FL14U8GOtherBCBS
GA003147334AMedicaid
FL011137000Medicaid