Healthcare Provider Details

I. General information

NPI: 1720534068
Provider Name (Legal Business Name): MR. JACOB R CORBIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LOTHROP STREET (UPMC PRESBY- CCM OFFICE) 6 FLOOR SCAIFE HALL
PITTSBURGH PA
15232
US

IV. Provider business mailing address

205 LEHIGH AVE APT 1
SHADYSIDE PA
15232-1725
US

V. Phone/Fax

Practice location:
  • Phone: 903-821-5827
  • Fax:
Mailing address:
  • Phone: 903-821-5827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberSP016133
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: