Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 232582 | MA |
N | 208000000X | Pediatrician | 23933 | SC |
NPI | 1003903998 |
---|---|
Provider Name | Dr. Lisa Brancato Corkins |
First Address | Quincy, MA 02169 |
Second Address | Quincy, MA 02169 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 15/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01017B | (02) | |
2148935 | (05) | MA |