MEDICARE: KATHLEEN A CORCORAN PA-C

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	363A00000X	Physician Assistant	OA003043	PA
2	363A00000X	Physician Assistant	MA055881	PA
3	363A00000X	Physician Assistant	C5-0000843	DE

General Provider Information

NPI Number	:	1245576370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN A CORCORAN PA-C

Provider Business Mailing Address
First Line	:	1800 CONCORD PIKE
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19897-0001
Country	:	US
Telephone Number	:	302-886-3241
Fax Number	:	302-886-5041

Provider Business Practice Location Address
First Line	:	1800 CONCORD PIKE
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19897-0001
Country	:	US
Telephone Number	:	302-886-3241
Fax Number	:	302-886-5041

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

Provider Enumeration Date	:	12/18/2012
Last Update Date	:	02/17/2023

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Directions to “ KATHLEEN A CORCORAN PA-C” Practice Location

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