MEDICARE: MS. PATRICIA DIANE CORBIN 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	MA001604-L	PA

General Provider Information

NPI Number	:	1891804902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA DIANE CORBIN PA-C

Provider Business Mailing Address
First Line	:	PO BOX 450
Second Line	:
City	:	BRUCETON MILLS
State	:	WV
Zip	:	26525-0450
Country	:	US
Telephone Number	:	304-379-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1640 SKYVIEW DRIVE
Second Line	:	USP HAZELTON HEALTH SERVICES
City	:	BRUCETON MILLS
State	:	WV
Zip	:	26525
Country	:	US
Telephone Number	:	304-379-5000
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/29/2011

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