Provider Demographics
NPI:1043328404
Name:NEGRI, CORY ALLAN (DPM)
Entity type:Individual
Prefix:DR
First Name:CORY
Middle Name:ALLAN
Last Name:NEGRI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5709 CHURCHLAND BLVD
Mailing Address - Street 2:B
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-3314
Mailing Address - Country:US
Mailing Address - Phone:757-484-7412
Mailing Address - Fax:757-686-8049
Practice Address - Street 1:5709 CHURCHLAND BLVD
Practice Address - Street 2:B
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-3314
Practice Address - Country:US
Practice Address - Phone:757-484-7412
Practice Address - Fax:757-686-8049
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000728213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA480006062RRMCROtherPALMETTO GBA
VA009302565Medicaid
VA028304BCBSOtherANTHEM BCBS
VA480000132Medicare ID - Type Unspecified
VA009302565Medicaid