Provider Demographics
NPI:1417926205
Name:CORCORAN, CORI CHRISTINE (PA-C)
Entity Type:Individual
Prefix:
First Name:CORI
Middle Name:CHRISTINE
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 1:2103 BECKETTS RDG
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-6644
Mailing Address - Country:US
Mailing Address - Phone:919-360-8338
Mailing Address - Fax:
Practice Address - Street 1:508 FULTON ST
Practice Address - Street 2:DEPT OF ANESTHESIOLOGY, 112C
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3875
Practice Address - Country:US
Practice Address - Phone:919-286-0411
Practice Address - Fax:919-286-6853
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103265363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1050474OtherNATIONAL CERTIFICATE NUMB
NC103265OtherSTATE LICENSE NUMBER
NC103265OtherSTATE LICENSE NUMBER