MEDICARE: JEAN VALENTINE CORCORAN MD

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	207R00000X	Internal Medicine Physician	01033742A	IN

General Provider Information

NPI Number	:	1306188370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN VALENTINE CORCORAN MD

Provider Business Mailing Address
First Line	:	875 SUGARBUSH RDG
Second Line	:
City	:	ZIONSVILLE
State	:	IN
Zip	:	46077-1911
Country	:	US
Telephone Number	:	317-873-3598
Fax Number	:	317-873-6816

Provider Business Practice Location Address
First Line	:	875 SUGARBUSH RDG
Second Line	:
City	:	ZIONSVILLE
State	:	IN
Zip	:	46077-1911
Country	:	US
Telephone Number	:	317-873-3598
Fax Number	:	317-873-6816

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

Provider Enumeration Date	:	03/18/2013
Last Update Date	:	03/18/2013

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