1417910019 NPI number — DR. SANDRA LEIGH CORBETT DO

Table of content: DR. SANDRA LEIGH CORBETT DO (NPI 1417910019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417910019 NPI number — DR. SANDRA LEIGH CORBETT DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORBETT
Provider First Name:
SANDRA
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAUER
Provider Other First Name:
SANDRA
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417910019
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
127 LONG SANDS RD
Provider Second Line Business Mailing Address:
SUITE 11
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
03909-1158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-363-8430
Provider Business Mailing Address Fax Number:
207-351-3006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
127 LONG SANDS RD
Provider Second Line Business Practice Location Address:
SUITE 11
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
03909-1158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-363-8430
Provider Business Practice Location Address Fax Number:
207-351-3006
Provider Enumeration Date:
04/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  1776 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010467585 . This is a "MACHIGONNE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 04YP05087ME01 . This is a "ANTHEM BCBS NEW HAMPSHIRE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010467585 . This is a "AETNA NONHMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 596163 . This is a "AETNA NONHMO GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: ME0072 . This is a "MEDICARE B" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010467585 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 241060099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: YORK083565 . This is a "ANTHEM BCBS NEW HAMPSHIRE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010467585 . This is a "CHAMPUS GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 046483 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 241060099 . This is a "PRIMECARE MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 593163 . This is a "AETNA HMO GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00066099 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5231124 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010467585001 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA6330 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010467585 . This is a "STANDARD TAX ID" identifier . This identifiers is of the category "OTHER".




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