Healthcare Provider Details

I. General information

NPI: 1750558482
Provider Name (Legal Business Name): REBECCA LYNN CORBETT HULTMAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA LYNN CORBETT D.O.

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 HOSPITAL DR
YORK ME
03909-1011
US

IV. Provider business mailing address

15 HOSPITAL DR
YORK ME
03909-1011
US

V. Phone/Fax

Practice location:
  • Phone: 207-363-4321
  • Fax:
Mailing address:
  • Phone: 207-363-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number233201
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: