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General NPI Number Information
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NPI Number | 1437430741
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Entity Type | Organization
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Legal Business Name | KENNETH M. CORRIN, JR., M.D., P.A.
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Dates
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Enumeration Date | 08/31/2011
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Last Update Date | 08/31/2011
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Provider Practice Location Address
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Address Line | 1307 N RODNEY ST
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City | WILMINGTON
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State | DE
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Zip | 19806-4226
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Country | US
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Telephone | 302-654-2226
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Fax | 302-654-9026
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Provider Business Mailing Address
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Address Line | 1307 N RODNEY ST
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City | WILMINGTON
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State | DE
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Zip | 19806-4226
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Country | US
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Telephone | 302-654-2226
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Fax | 302-654-9026
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Authorized Official
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Title or Position | MEDICAL ASSISTANT
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Name | MS. MARY MCGONIGLE
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Credential | M.A.
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Telephone | 302-654-2226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | C10000284
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License Number State | DE
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