Provider Demographics
NPI:1194366856
Name:SEVIGNY, COREY
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:SEVIGNY
Suffix:
Gender:M
Credentials:
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 2032
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03302-2032
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 WEST ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3548
Practice Address - Country:US
Practice Address - Phone:603-225-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA042611055OtherTAX ID
MA0000023532OtherBMC
MA99618201OtherNETWORK HEALTH
MAM18633OtherBCBS
MA10047445OtherFALLON
MA1004745OtherNHP
MA1303287OtherMBHP