Provider Demographics
NPI:1720534068
Name:CORBIN, JACOB R
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:R
Last Name:CORBIN
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 1:205 LEHIGH AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:SHADYSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1725
Mailing Address - Country:US
Mailing Address - Phone:903-821-5827
Mailing Address - Fax:
Practice Address - Street 1:200 LOTHROP STREET (UPMC PRESBY- CCM OFFICE)
Practice Address - Street 2:6 FLOOR SCAIFE HALL
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232
Practice Address - Country:US
Practice Address - Phone:903-821-5827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016133363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine