Provider Demographics
NPI:1477634681
Name:CORDTS, ALAN EDWIN (MD)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:EDWIN
Last Name:CORDTS
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 1:78 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540
Mailing Address - Country:US
Mailing Address - Phone:508-367-3937
Mailing Address - Fax:928-729-8268
Practice Address - Street 1:78 MAIN STREET
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540
Practice Address - Country:US
Practice Address - Phone:508-367-3937
Practice Address - Fax:508-548-7407
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39282208600000X, 2086S0129X
AZ47782208600000X
OK31234208600000X
MA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2097699Medicaid
MA2097699Medicaid
MAC0L07175Medicare ID - Type Unspecified