Provider Demographics
NPI:1184087132
Name:CORGAN, SONDRA L (MD)
Entity type:Individual
Prefix:DR
First Name:SONDRA
Middle Name:L
Last Name:CORGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 E CITY AVE STE PL13
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1506
Mailing Address - Country:US
Mailing Address - Phone:267-224-1745
Mailing Address - Fax:973-440-3267
Practice Address - Street 1:333 E CITY AVE STE PL13
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1506
Practice Address - Country:US
Practice Address - Phone:267-225-1745
Practice Address - Fax:973-440-3267
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2022-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4685492084P0800X, 2084P0804X
PAMT219443390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program