Healthcare Provider Details

I. General information

NPI: 1184658627
Provider Name (Legal Business Name): SHANE A CORBITT P.A.-C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 ANN ST
PARKERSBURG WV
26101-2504
US

IV. Provider business mailing address

1905 ANN ST
PARKERSBURG WV
26101-2504
US

V. Phone/Fax

Practice location:
  • Phone: 304-424-4150
  • Fax: 304-424-4151
Mailing address:
  • Phone: 304-424-4150
  • Fax: 304-424-4151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number01164
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: