Provider Demographics
NPI:1093711020
Name:CORCORAN, JOSEPH MICHAEL (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:CORCORAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:J
Other - Middle Name:MICHAEL
Other - Last Name:CORCORAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:30 S VALLEY RD
Mailing Address - Street 2:STE 102
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1469
Mailing Address - Country:US
Mailing Address - Phone:610-647-1996
Mailing Address - Fax:610-408-8677
Practice Address - Street 1:30 S VALLEY RD
Practice Address - Street 2:STE 102
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1469
Practice Address - Country:US
Practice Address - Phone:610-647-1996
Practice Address - Fax:610-408-8677
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-000620-E208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA804015OtherUNITED HEALTHCARE
PA0000195952OtherBLUE SHIELD NUMBER
PA8495471OtherAETNA PROVIDER NUMBER
PA244751OtherMAMSI PROVIDER NUMBER
PAA522319OtherOXFORD HEALTH PLANS
PA8495471OtherAETNA PROVIDER NUMBER
PA244751OtherMAMSI PROVIDER NUMBER