Provider Demographics
NPI:1306188370
Name:CORCORAN, JEAN VALENTINE (MD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:VALENTINE
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 1:875 SUGARBUSH RDG
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-1911
Mailing Address - Country:US
Mailing Address - Phone:317-873-3598
Mailing Address - Fax:317-873-6816
Practice Address - Street 1:875 SUGARBUSH RDG
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1911
Practice Address - Country:US
Practice Address - Phone:317-873-3598
Practice Address - Fax:317-873-6816
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033742A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine