Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | 55787 | CT |
NPI | 1366768343 |
---|---|
Provider Name | Kathleen Jo Elayda Corbin |
First Address | New Haven, CT 06510-3206 |
Second Address | New Haven, CT 06510-3218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2010 |
Last Update Date | 04/10/2016 |