Healthcare Provider Details

I. General information

NPI: 1154173151
Provider Name (Legal Business Name): ELENA ISABEL CORBIN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 HOSPITAL RD STE 260
CHILLICOTHEE OH
45601-9031
US

IV. Provider business mailing address

65 HANOVER DR
CHILLICOTHEE OH
45601-1091
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-4370
  • Fax:
Mailing address:
  • Phone: 174-080-4926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.008937RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: