Provider Demographics
NPI:1750841516
Name:CORSE, ANDREW KENNEDY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:KENNEDY
Last Name:CORSE
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 1:576 HARTNELL ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2833
Mailing Address - Country:US
Mailing Address - Phone:831-625-4600
Mailing Address - Fax:
Practice Address - Street 1:576 HARTNELL ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2833
Practice Address - Country:US
Practice Address - Phone:831-625-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1776962084P0800X, 2084P0800X
CAPTL10432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry