Provider Demographics
NPI:1124185418
Name:CORRISS, ROBBIE R (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ROBBIE
Middle Name:R
Last Name:CORRISS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WHITEHALL RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-3226
Mailing Address - Country:US
Mailing Address - Phone:603-994-7600
Mailing Address - Fax:603-335-8135
Practice Address - Street 1:11 WHITEHALL RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-3226
Practice Address - Country:US
Practice Address - Phone:603-335-8132
Practice Address - Fax:603-335-8135
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0265P363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30338896Medicaid
NHAP101002Medicare PIN
NHAP1010Medicare PIN
NHS75600Medicare UPIN
NH30338896Medicaid