Provider Demographics
NPI:1417910019
Name:CORBETT, SANDRA LEIGH (DO)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LEIGH
Last Name:CORBETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LEIGH
Other - Last Name:BAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:127 LONG SANDS RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1158
Mailing Address - Country:US
Mailing Address - Phone:207-363-8430
Mailing Address - Fax:207-351-3006
Practice Address - Street 1:127 LONG SANDS RD
Practice Address - Street 2:SUITE 11
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1158
Practice Address - Country:US
Practice Address - Phone:207-363-8430
Practice Address - Fax:207-351-3006
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1776207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
010467585OtherMACHIGONNE
04YP05087ME01OtherANTHEM BCBS NEW HAMPSHIRE
010467585OtherAETNA NONHMO
596163OtherAETNA NONHMO GROUP
ME0072OtherMEDICARE B
010467585OtherAETNA HMO
ME241060099Medicaid
YORK083565OtherANTHEM BCBS NEW HAMPSHIRE
010467585OtherCHAMPUS GROUP
046483OtherANTHEM BLUE CROSS BLUE SH
241060099OtherPRIMECARE MEDICAID
593163OtherAETNA HMO GROUP
P00066099OtherRAILROAD MEDICARE
5231124OtherCIGNA HEALTHCARE
010467585001OtherANTHEM BLUE CROSS BLUE SH
AA6330OtherHARVARD PILGRIM
010467585OtherSTANDARD TAX ID
ME241060099Medicaid
010467585OtherAETNA HMO