MEDICARE: DR. TIMOTHY ALAN CORBA 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	208000000X	Pediatrics Physician	01057376A	IN

General Provider Information

NPI Number	:	1356458202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY ALAN CORBA MD

Provider Business Mailing Address
First Line	:	223 W SPRING ST
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-3612
Country	:	US
Telephone Number	:	812-949-1616
Fax Number	:	812-945-8365

Provider Business Practice Location Address
First Line	:	223 W SPRING ST
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-3612
Country	:	US
Telephone Number	:	812-949-1616
Fax Number	:	812-945-8365

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	07/08/2007

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