Basic Information
| Provider Information | |||||||||
| NPI: | 1255386322 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORBIN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2520 VALLEY DR | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | PT PLEASANT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 255502031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046752229 | ||||||||
| FaxNumber: | 3046755893 | ||||||||
| Practice Location | |||||||||
| Address1: | 2520 VALLEY DR | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | PT PLEASANT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 255502031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046752229 | ||||||||
| FaxNumber: | 3046755068 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 03/19/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | N | Other Service Providers | Specialist | 174400000X | 183778 | NY | N | Other Service Providers | Specialist | 207V00000X | 19349 | WV | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 0101051224 | VA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0093738003 | 05 | WV | MEDICAID | 2060040 | 05 | OH | MEDICAID | 0093738002 | 05 | WV | MEDICAID | 183778 | 01 | NY | LICENSE REGISTRATION | OTHER |