Provider Demographics
NPI:1922516228
Name:CORBESERO, MEGHAN KATHLEEN (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:KATHLEEN
Last Name:CORBESERO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:
Other - Last Name:CULBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1840 AMHERST ST STE 2B
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2808
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1870 AMHERST ST STE 310
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2873
Practice Address - Country:US
Practice Address - Phone:540-536-6721
Practice Address - Fax:540-536-6724
Is Sole Proprietor?:No
Enumeration Date:2018-01-21
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
VA0110-006073363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant