Provider Demographics
NPI:1932209335
Name:CORBETT, TIMOTHY WILEY SR (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:WILEY
Last Name:CORBETT
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:324 COMMERCE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-2794
Mailing Address - Country:US
Mailing Address - Phone:434-392-9366
Mailing Address - Fax:434-392-9348
Practice Address - Street 1:324 COMMERCE RD
Practice Address - Street 2:SUITE A
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-2794
Practice Address - Country:US
Practice Address - Phone:434-392-9366
Practice Address - Fax:434-392-9348
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2011-07-27
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Provider Licenses
StateLicense IDTaxonomies
VA0101057605207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010299161Medicaid
VAA72398Medicare UPIN
VA010299161Medicaid