MEDICARE: MIKE CORCORAN CPO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224P00000X	Prosthetist	CPO 1928	VA

General Provider Information

NPI Number	:	1093892416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKE CORCORAN CPO

Provider Business Mailing Address
First Line	:	2421 LINDEN LN
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-1230
Country	:	US
Telephone Number	:	301-585-5347
Fax Number	:

Provider Business Practice Location Address
First Line	:	2421 LINDEN LN
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-1230
Country	:	US
Telephone Number	:	301-585-5347
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	03/12/2024

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