Provider Demographics
NPI:1609030089
Name:CORSON-DIAZ, CATHY (MD)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:CORSON-DIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 EGG HARBOR RD STE C9
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-3152
Mailing Address - Country:US
Mailing Address - Phone:856-589-1151
Mailing Address - Fax:856-589-1554
Practice Address - Street 1:380 EGG HARBOR RD STE C9
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-3152
Practice Address - Country:US
Practice Address - Phone:856-589-1151
Practice Address - Fax:856-589-1554
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA061653208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice