Healthcare Provider Details

I. General information

NPI: 1740220854
Provider Name (Legal Business Name): MARK E CORCORAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 S BURNETT RD
SPRINGFIELD OH
45505-2720
US

IV. Provider business mailing address

392 E STONEQUARRY RD STE 441
VANDALIA OH
45377-9677
US

V. Phone/Fax

Practice location:
  • Phone: 937-328-3385
  • Fax: 937-328-3387
Mailing address:
  • Phone: 937-308-0056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.053772
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.053772
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: