Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CPO 1928 | VA |
NPI | 1093892416 |
---|---|
Provider Name | Mike Corcoran |
First Address | Silver Spring, MD 20910-1230 |
Second Address | Silver Spring, MD 20910-1230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |