Provider Demographics
NPI:1700311693
Name:CORNELIUS, JENNIFER (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:CORNELIUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 EMILY LN
Mailing Address - Street 2:
Mailing Address - City:ROWLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01969-2235
Mailing Address - Country:US
Mailing Address - Phone:207-606-9095
Mailing Address - Fax:
Practice Address - Street 1:41 EMILY LN
Practice Address - Street 2:
Practice Address - City:ROWLEY
Practice Address - State:MA
Practice Address - Zip Code:01969-2235
Practice Address - Country:US
Practice Address - Phone:207-606-9095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0100823208D00000X
VA0101282052208D00000X
DCMD210011857208D00000X
NY325643208D00000X
TXL5708208D00000X
FLTPME5944208D00000X
NC2024-03133208D00000X
GA102237208D00000X
DEC1-0005427208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice