Provider Demographics
NPI:1740284272
Name:CORBETT, DAVID (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CORBETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2874 WARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-1761
Mailing Address - Country:US
Mailing Address - Phone:252-291-5600
Mailing Address - Fax:252-291-6935
Practice Address - Street 1:2874 WARD BLVD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-1761
Practice Address - Country:US
Practice Address - Phone:252-291-5600
Practice Address - Fax:252-291-6935
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC128E0 BCBSOtherBCBS
NC89128E0Medicaid
NCH32350Medicare UPIN
NC128E0 BCBSOtherBCBS