Healthcare Provider Details

I. General information

NPI: 1861263568
Provider Name (Legal Business Name): CORBIN SCHMUCKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 WASHINGTON RD STE 101
WESTMINSTER MD
21157-6664
US

IV. Provider business mailing address

2809 HILLCREST AVE
PARKVILLE MD
21234-6314
US

V. Phone/Fax

Practice location:
  • Phone: 410-876-5600
  • Fax:
Mailing address:
  • Phone: 301-852-8676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number5819
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: