Provider Demographics
NPI:1184601262
Name:CORBIN, SAMUEL J JR (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:J
Last Name:CORBIN
Suffix:JR
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 1:18 BARNETTE DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-8004
Mailing Address - Country:US
Mailing Address - Phone:803-775-6308
Mailing Address - Fax:803-778-1853
Practice Address - Street 1:18 BARNETTE DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-8004
Practice Address - Country:US
Practice Address - Phone:803-775-6308
Practice Address - Fax:803-778-1853
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5350208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC000000149363OtherUNISON HEALTH PLAN
SC0191552OtherUNITED HEALTH CARE
SC053505Medicaid
P00451777OtherRAILROAD MEDICARE PTAN
SC61271OtherPREMIER HEALTH SYSTEMS
SC0191552OtherUNITED HEALTH CARE
SCD99149Medicare UPIN