Provider Demographics
NPI:1477614543
Name:RICHARD CORSON MD LLC
Entity Type:Organization
Organization Name:RICHARD CORSON MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:CORSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-722-9962
Mailing Address - Street 1:313 COURTYARD DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-4253
Mailing Address - Country:US
Mailing Address - Phone:908-722-9962
Mailing Address - Fax:908-722-9963
Practice Address - Street 1:313 COURTYARD DR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4253
Practice Address - Country:US
Practice Address - Phone:908-722-9962
Practice Address - Fax:908-722-9963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4825101Medicaid
NJ4825101Medicaid