Provider Demographics
NPI:1558531475
Name:CORRIGAN, JONATHAN P (PA-C)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:P
Last Name:CORRIGAN
Suffix:
Gender:M
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 1:3755 ORANGE PL STE 101
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4455
Mailing Address - Country:US
Mailing Address - Phone:844-746-8537
Mailing Address - Fax:216-450-1810
Practice Address - Street 1:3755 ORANGE PL STE 101
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4455
Practice Address - Country:US
Practice Address - Phone:844-746-8537
Practice Address - Fax:216-450-1810
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD-592363A00000X
CAPA52977363A00000X
OH50-002662363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0079005Medicaid