1417926205 NPI number — CORI CHRISTINE CORCORAN PA-C

Table of content: CORI CHRISTINE CORCORAN PA-C (NPI 1417926205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417926205 NPI number — CORI CHRISTINE CORCORAN PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORCORAN
Provider First Name:
CORI
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

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:
1417926205
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2103 BECKETTS RDG
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLSBOROUGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27278-6644
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-360-8338
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
508 FULTON ST
Provider Second Line Business Practice Location Address:
DEPT OF ANESTHESIOLOGY, 112C
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27705-3875
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-286-0411
Provider Business Practice Location Address Fax Number:
919-286-6853
Provider Enumeration Date:
03/15/2006

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: 363A00000X , with the licence number:  103265 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1050474 . This is a "NATIONAL CERTIFICATE NUMB" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 103265 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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