Provider Demographics
NPI:1770760217
Name:JERRY L. CORRECES,MD.,P.C.
Entity type:Organization
Organization Name:JERRY L. CORRECES,MD.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CORRECES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-797-4593
Mailing Address - Street 1:1124 OPAL CT
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5940
Mailing Address - Country:US
Mailing Address - Phone:301-797-4593
Mailing Address - Fax:301-665-9440
Practice Address - Street 1:1124 OPAL CT
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5940
Practice Address - Country:US
Practice Address - Phone:301-797-4593
Practice Address - Fax:301-665-9440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
110068995OtherMEDICARE RAILROAD
X63514Medicare UPIN
110068995OtherMEDICARE RAILROAD