Healthcare Provider Details

I. General information

NPI: 1396842324
Provider Name (Legal Business Name): JOSE BIGOL CORVERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 FOX KNOLL CT
TIMONIUM MD
21093-2847
US

IV. Provider business mailing address

9 FOX KNOLL CT
TIMONIUM MD
21093-2847
US

V. Phone/Fax

Practice location:
  • Phone: 410-252-1733
  • Fax: 410-252-0455
Mailing address:
  • Phone: 410-252-1733
  • Fax: 410-252-0455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberD0015082
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: