Provider Demographics
NPI:1336141738
Name:CORCORAN, KEVIN J (DO)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:CORCORAN
Suffix:
Gender:M
Credentials:DO
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 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:252-744-3520
Mailing Address - Fax:252-744-3194
Practice Address - Street 1:2100 STANTONSBURG RD
Practice Address - Street 2:PITT COUNTY MEMORIAL HOSPITAL EMERGENCY MEDICINE
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2818
Practice Address - Country:US
Practice Address - Phone:252-744-2207
Practice Address - Fax:252-744-5014
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89130VWMedicaid
NC130VWOtherBCBS NC
NC89130VWMedicaid
NCD19245Medicare UPIN