Provider Demographics
NPI:1417967373
Name:CORBETT, MICHAEL L (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:CORBETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CHESTNUT ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2497
Mailing Address - Country:US
Mailing Address - Phone:781-444-5080
Mailing Address - Fax:781-449-5027
Practice Address - Street 1:300 CHESTNUT ST
Practice Address - Street 2:SUITE 900
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2497
Practice Address - Country:US
Practice Address - Phone:781-444-5080
Practice Address - Fax:781-449-5027
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA39517207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA701741OtherTUFTS
MAV03443OtherBLUECROSSBLUESHIELD
MA17425OtherHARVARD PILGRIM
MAV03443OtherBLUECROSSBLUESHIELD
MA17425OtherHARVARD PILGRIM