Provider Demographics
NPI:1174504823
Name:CORBETT, KEVIN JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JOHN
Last Name:CORBETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:223 CHIEF JUSTICE CUSHING HWY
Mailing Address - Street 2:STE 101
Mailing Address - City:COHASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02025-1391
Mailing Address - Country:US
Mailing Address - Phone:781-383-6800
Mailing Address - Fax:781-383-6504
Practice Address - Street 1:223 CHIEF JUSTICE CUSHING HWY
Practice Address - Street 2:STE 101
Practice Address - City:COHASSET
Practice Address - State:MA
Practice Address - Zip Code:02025-1391
Practice Address - Country:US
Practice Address - Phone:781-383-6800
Practice Address - Fax:781-383-6504
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA54375208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
457039OtherTUFTS USFHP
MA6192335Medicaid
711832OtherTUFTS
MACO J04340OtherBCBS
MA20260OtherHPHC
1200506OtherUNITED
355288OtherCIGNA
355288OtherCIGNA
J0434001Medicare PIN