Provider Demographics
NPI:1710070982
Name:CORVIN, GEORGE PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:PATRICK
Last Name:CORVIN
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 1:5530 MUNFORD ROAD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-2638
Mailing Address - Country:US
Mailing Address - Phone:919-782-9554
Mailing Address - Fax:919-782-9130
Practice Address - Street 1:5530 MUNFORD ROAD
Practice Address - Street 2:SUITE 119
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-2638
Practice Address - Country:US
Practice Address - Phone:919-782-9554
Practice Address - Fax:919-782-9130
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97-005192084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F72690Medicare UPIN
2242084Medicare ID - Type Unspecified