Healthcare Provider Details

I. General information

NPI: 1972588507
Provider Name (Legal Business Name): GERALD P CORCORAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 ROSEMARY ST STE C
NEEDHAM MA
02494-3259
US

IV. Provider business mailing address

131 FAIR OAKS PARK
NEEDHAM MA
02492-3015
US

V. Phone/Fax

Practice location:
  • Phone: 781-444-5515
  • Fax: 781-444-1866
Mailing address:
  • Phone: 781-444-8844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33120
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: