Provider Demographics
NPI:1972572121
Name:CORBETT, LAWRENCE P (DO)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:P
Last Name:CORBETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:400 PATROON CREEK BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-5012
Mailing Address - Country:US
Mailing Address - Phone:518-459-8106
Mailing Address - Fax:518-489-6441
Practice Address - Street 1:400 PATROON CREEK BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-5012
Practice Address - Country:US
Practice Address - Phone:518-459-8106
Practice Address - Fax:518-489-6441
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1160512084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00531833Medicaid
NYB77015Medicare UPIN
NY00531833Medicaid
NY50348EMedicare ID - Type Unspecified