Provider Demographics
NPI:1245888601
Name:PELSOR, CORRY MCMULLEN
Entity type:Individual
Prefix:
First Name:CORRY
Middle Name:MCMULLEN
Last Name:PELSOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HOMESTEAD WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:ME
Mailing Address - Zip Code:04357-3728
Mailing Address - Country:US
Mailing Address - Phone:207-737-7000
Mailing Address - Fax:207-737-7028
Practice Address - Street 1:3 HOMESTEAD WAY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:ME
Practice Address - Zip Code:04357-3728
Practice Address - Country:US
Practice Address - Phone:207-737-7000
Practice Address - Fax:207-737-7028
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT5390208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation