1982694774 NPI number — DR. CRAIG KORBIN MD

Table of content: DR. CRAIG KORBIN MD (NPI 1982694774)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982694774 NPI number — DR. CRAIG KORBIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KORBIN
Provider First Name:
CRAIG
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982694774
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
350 W COLUMBIA ST STE 420
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47710-1782
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-422-3254
Provider Business Mailing Address Fax Number:
812-426-6388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 POMFRET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PUTNAM
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06260-1836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-963-6356
Provider Business Practice Location Address Fax Number:
860-963-6335
Provider Enumeration Date:
10/24/2005

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: 2085R0202X , with the licence number:  036830 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004223541 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100209450 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200387190B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300084499 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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