Basic Information
| Provider Information | |||||||||
| NPI: | 1003947664 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MICHAEL J CORRIGAN MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 67 SHAWVILLE RD | ||||||||
| Address2: | |||||||||
| City: | SHELDON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054838383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8029335702 | ||||||||
| FaxNumber: | 8029335702 | ||||||||
| Practice Location | |||||||||
| Address1: | 12 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | SWANTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054881403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028683175 | ||||||||
| FaxNumber: | 8028682923 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 01/18/2019 | ||||||||
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| AuthorizedOfficialLastName: | CORRIGAN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8028683175 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0005690 | 05 | VT | MEDICAID |