Healthcare Provider Details

I. General information

NPI: 1952399131
Provider Name (Legal Business Name): THOMAS BRYAN CORKERY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL BLVD
CANONSBURG PA
15317-9762
US

IV. Provider business mailing address

160 GALLERY DR STE 300
MC MURRAY PA
15317-2690
US

V. Phone/Fax

Practice location:
  • Phone: 724-941-7144
  • Fax: 724-941-7625
Mailing address:
  • Phone: 724-941-7144
  • Fax: 724-941-7625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS0005956L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS005956L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: