Healthcare Provider Details

I. General information

NPI: 1396716353
Provider Name (Legal Business Name): DELLA M CORCORAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 FARMINGTON AVE STE 201
WEST HARTFORD CT
06107
US

IV. Provider business mailing address

970 FARMINGTON AVE STE 201
WEST HARTFORD CT
06107
US

V. Phone/Fax

Practice location:
  • Phone: 860-561-4300
  • Fax: 860-561-1635
Mailing address:
  • Phone: 860-561-4300
  • Fax: 860-561-1635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number035822
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: