Provider Demographics
NPI:1255386322
Name:CORBIN, MICHAEL W (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:CORBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2520 VALLEY DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:PT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-2031
Mailing Address - Country:US
Mailing Address - Phone:304-675-2229
Mailing Address - Fax:304-675-5893
Practice Address - Street 1:2520 VALLEY DR
Practice Address - Street 2:SUITE 215
Practice Address - City:PT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-2031
Practice Address - Country:US
Practice Address - Phone:304-675-2229
Practice Address - Fax:304-675-5068
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
174400000X
NY183778174400000X
WV19349207V00000X
VA0101051224207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0093738003Medicaid
OH2060040Medicaid
WV0093738002Medicaid
NY183778OtherLICENSE REGISTRATION
OH2060040Medicaid