Individual
MICHAEL CORLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
100 GRAND ST, NEW BRITAIN, CT 06052-2016
(860) 224-5011
Mailing address
100 GRAND ST, NEW BRITAIN, CT 06052-2016
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
4927
CT
363AS0400X
Surgical Physician Assistant
Primary
4927
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004927
CT LIC
CT
Enumeration date
07/24/2020
Last updated
06/11/2021
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