Healthcare Provider Details

I. General information

NPI: 1528191616
Provider Name (Legal Business Name): STEVEN CORVILLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 W BALTIMORE ST 1ST FLOOR
BALTIMORE MD
21223-2245
US

IV. Provider business mailing address

1104 S CONKLING ST
BALTIMORE MD
21224-5208
US

V. Phone/Fax

Practice location:
  • Phone: 410-362-4481
  • Fax:
Mailing address:
  • Phone: 410-362-4481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberD63287
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: