Basic Information
| Provider Information | |||||||||
| NPI: | 1194793703 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORRIGAN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1346 | ||||||||
| Address2: | |||||||||
| City: | WILLISTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054951346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8025271405 | ||||||||
| FaxNumber: | 8029335702 | ||||||||
| Practice Location | |||||||||
| Address1: | 12 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | SWANTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054881403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028683175 | ||||||||
| FaxNumber: | 8028682923 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 04/08/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 42-0006830 | VT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0005690 | 05 | VT | MEDICAID |