Provider Demographics
NPI:1245576370
Name:CORCORAN, KATHLEEN A (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:CORCORAN
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 1:1800 CONCORD PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19897-0001
Mailing Address - Country:US
Mailing Address - Phone:302-886-3241
Mailing Address - Fax:302-886-5041
Practice Address - Street 1:1800 CONCORD PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19897-0001
Practice Address - Country:US
Practice Address - Phone:302-886-3241
Practice Address - Fax:302-886-5041
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA003043363A00000X
PAMA055881363A00000X
DEC5-0000843363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant