1437286200 NPI number — SCOTT E. CORCORAN

Table of content: SCOTT E. CORCORAN (NPI 1437286200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437286200 NPI number — SCOTT E. CORCORAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORCORAN
Provider First Name:
SCOTT
Provider Middle Name:
E.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1437286200
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8406 CHERRY VALLEY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22309-2120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-373-3097
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 LUKE AVE
Provider Second Line Business Practice Location Address:
ROOM 400, HQ USAF SG8X
Provider Business Practice Location Address City Name:
BOLLING AIR FORCE BASE
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20032-7050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-767-0297
Provider Business Practice Location Address Fax Number:
202-767-5053
Provider Enumeration Date:
02/27/2007

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: 183500000X , with the licence number:  4321 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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