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General NPI Number Information
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NPI Number | 1184087132
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Entity Type | Individual
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Provider Name | SONDRA L CORGAN MD
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Gender | Female
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Dates
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Enumeration Date | 03/29/2016
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Last Update Date | 12/04/2022
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Provider Practice Location Address
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Address Line | 333 E CITY AVE STE PL13
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City | BALA CYNWYD
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State | PA
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Zip | 19004-1506
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Country | US
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Telephone | 267-225-1745
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Fax | 973-440-3267
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Provider Business Mailing Address
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Address Line | 333 E CITY AVE STE PL13
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City | BALA CYNWYD
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State | PA
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Zip | 19004-1506
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Country | US
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Telephone | 267-224-1745
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Fax | 973-440-3267
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD468549
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | MT219443
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | MD468549
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License Number State | PA
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