Provider Demographics
NPI:1710664040
Name:CORBETT, DONALD WADE
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:WADE
Last Name:CORBETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 RADFORD LN
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-6190
Mailing Address - Country:US
Mailing Address - Phone:802-343-3780
Mailing Address - Fax:
Practice Address - Street 1:34 RADFORD LN
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-6190
Practice Address - Country:US
Practice Address - Phone:802-343-3780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT90717731343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)