Provider Demographics
NPI:1396716353
Name:CORCORAN, DELLA M (MD)
Entity type:Individual
Prefix:MRS
First Name:DELLA
Middle Name:M
Last Name:CORCORAN
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 1:970 FARMINGTON AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107
Mailing Address - Country:US
Mailing Address - Phone:860-561-4300
Mailing Address - Fax:860-561-1635
Practice Address - Street 1:970 FARMINGTON AVE
Practice Address - Street 2:STE 201
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107
Practice Address - Country:US
Practice Address - Phone:860-561-4300
Practice Address - Fax:860-561-1635
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0358222080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
010035822CT01OtherBCBS
038522OtherCONNECTICARE
010035822CT01OtherBCBS