Provider Demographics
NPI:1790858637
Name:CORNELIUS, CHRIS ROBERT (MD)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:ROBERT
Last Name:CORNELIUS
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 1:3 DOGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-3774
Mailing Address - Country:US
Mailing Address - Phone:802-345-0851
Mailing Address - Fax:
Practice Address - Street 1:5170 STATE ROUTE 405
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:PA
Practice Address - Zip Code:17847-7510
Practice Address - Country:US
Practice Address - Phone:570-246-4575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0010037207Q00000X
FLME76538207Q00000X
PAMD486268207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT59378OtherBCBS
VTP00168543OtherMEDICARE RAILROAD
VT1009665Medicaid
VT08497OtherMVP
VT3203553OtherCIGNA
VT08497OtherMVP
VTP00168543OtherMEDICARE RAILROAD