Healthcare Provider Details

I. General information

NPI: 1457352403
Provider Name (Legal Business Name): CHRISTOPHER PETER CORCORAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 UNION STREET VETERANS CLINIC
CALAIS ME
04619
US

IV. Provider business mailing address

PO BOX 698
CALAIS ME
04619-0698
US

V. Phone/Fax

Practice location:
  • Phone: 207-904-3700
  • Fax: 207-904-3778
Mailing address:
  • Phone: 207-454-0209
  • Fax: 207-904-3778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number6691
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: