Provider Demographics
NPI:1952399131
Name:CORKERY, THOMAS BRYAN (DO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:BRYAN
Last Name:CORKERY
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 1:160 GALLERY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2690
Mailing Address - Country:US
Mailing Address - Phone:724-941-7144
Mailing Address - Fax:724-941-7625
Practice Address - Street 1:100 MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-9762
Practice Address - Country:US
Practice Address - Phone:724-941-7144
Practice Address - Fax:724-941-7625
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0005956L207R00000X
PAOS005956L208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001169480Medicaid
PAP00132797Medicare PIN
PACG1496Medicare PIN
PAE12960Medicare UPIN
PA178377NHMMedicare PIN
PA0011694800005Medicaid