Individual
DR. J RUSSELL CORCORAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
70 KENYON AVE, SUITE 215, WAKEFIELD, RI 02879-4239
(401) 783-0084
(401) 782-0005
Mailing address
100 KENYON AVE, WAKEFIELD, RI 02879-4216
(401) 788-3929
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
MD06582
RI
208M00000X
Hospitalist Physician
MD06582
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007056627
MEDICARE
—
05
—
9002371
—
RI
Enumeration date
09/29/2005
Last updated
08/07/2015
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