Provider Demographics
NPI:1497713085
Name:CORBITT, MARY L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:L
Last Name:CORBITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:L
Other - Last Name:RAGSDILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2215 WILDWOOD AVENUE
Mailing Address - Street 2:STE 105
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72120
Mailing Address - Country:US
Mailing Address - Phone:501-833-3833
Mailing Address - Fax:501-833-8191
Practice Address - Street 1:2215 WILDWOOD AVENUE
Practice Address - Street 2:STE 105
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72120
Practice Address - Country:US
Practice Address - Phone:501-833-3833
Practice Address - Fax:501-833-8191
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC46332084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR710650667Medicaid
AR710650667Medicaid
54234Medicare ID - Type Unspecified