1750303293 NPI number — MRS. BOBBI ELIZABETH CORBIN RD

Table of content: MRS. BOBBI ELIZABETH CORBIN RD (NPI 1750303293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750303293 NPI number — MRS. BOBBI ELIZABETH CORBIN RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORBIN
Provider First Name:
BOBBI
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750303293
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1108 CHEYENNES TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GERRARDSTOWN
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25420-4425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-263-0811
Provider Business Mailing Address Fax Number:
304-260-4860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 BUTLER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARTINSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-263-0811
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com