Healthcare Provider Details

I. General information

NPI: 1215924758
Provider Name (Legal Business Name): JAMES F.T. CORCORAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 06/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 BREMO RD SUITE 101
RICHMOND VA
23226-2438
US

IV. Provider business mailing address

2006 BREMO RD SUITE 101
RICHMOND VA
23226-2438
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-1881
  • Fax: 804-282-6413
Mailing address:
  • Phone: 804-288-1881
  • Fax: 804-282-6413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number0101033266
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101033266
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: