Healthcare Provider Details

I. General information

NPI: 1710108105
Provider Name (Legal Business Name): MICHAEL S CORBETT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 INDIA RD
CHARLOTTESVILLE VA
22901-2886
US

IV. Provider business mailing address

BOX 801097
CHARLOTTESVILLE VA
22908-0001
US

V. Phone/Fax

Practice location:
  • Phone: 434-978-4888
  • Fax:
Mailing address:
  • Phone: 434-806-8766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110-005238
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: