Provider Demographics
NPI:1326662909
Name:MAIR, COREY ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:ELIZABETH
Last Name:MAIR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COMMERCE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-1186
Mailing Address - Country:US
Mailing Address - Phone:401-793-8484
Mailing Address - Fax:401-793-8481
Practice Address - Street 1:1 COMMERCE ST STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1186
Practice Address - Country:US
Practice Address - Phone:401-793-8484
Practice Address - Fax:401-793-8481
Is Sole Proprietor?:No
Enumeration Date:2020-05-30
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIPA01235363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant