Provider Demographics
NPI:1093880411
Name:CORCORAN, TERESA R (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:R
Last Name:CORCORAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 598
Mailing Address - Street 2:
Mailing Address - City:HARWICH PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02646-0598
Mailing Address - Country:US
Mailing Address - Phone:508-905-2800
Mailing Address - Fax:508-240-1244
Practice Address - Street 1:710 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARWICH PORT
Practice Address - State:MA
Practice Address - Zip Code:02646-1931
Practice Address - Country:US
Practice Address - Phone:508-432-1400
Practice Address - Fax:508-430-2333
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77702207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ14240OtherBCBS MA
MA3117791Medicaid
MAOX1072Medicare PIN
MA3117791Medicaid