Basic Information
Provider Information | |||||||||
NPI: | 1417910019 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CORBETT | ||||||||
FirstName: | SANDRA | ||||||||
MiddleName: | LEIGH | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BAUER | ||||||||
OtherFirstName: | SANDRA | ||||||||
OtherMiddleName: | LEIGH | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 127 LONG SANDS RD | ||||||||
Address2: | SUITE 11 | ||||||||
City: | YORK | ||||||||
State: | ME | ||||||||
PostalCode: | 039091158 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2073638430 | ||||||||
FaxNumber: | 2073513006 | ||||||||
Practice Location | |||||||||
Address1: | 127 LONG SANDS RD | ||||||||
Address2: | SUITE 11 | ||||||||
City: | YORK | ||||||||
State: | ME | ||||||||
PostalCode: | 039091158 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2073638430 | ||||||||
FaxNumber: | 2073513006 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/07/2006 | ||||||||
LastUpdateDate: | 04/12/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 1776 | ME | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 010467585 | 01 |   | MACHIGONNE | OTHER | 04YP05087ME01 | 01 |   | ANTHEM BCBS NEW HAMPSHIRE | OTHER | 010467585 | 01 |   | AETNA NONHMO | OTHER | 596163 | 01 |   | AETNA NONHMO GROUP | OTHER | ME0072 | 01 |   | MEDICARE B | OTHER | 010467585 | 01 |   | AETNA HMO | OTHER | 241060099 | 05 | ME |   | MEDICAID | YORK083565 | 01 |   | ANTHEM BCBS NEW HAMPSHIRE | OTHER | 010467585 | 01 |   | CHAMPUS GROUP | OTHER | 046483 | 01 |   | ANTHEM BLUE CROSS BLUE SH | OTHER | 241060099 | 01 |   | PRIMECARE MEDICAID | OTHER | 593163 | 01 |   | AETNA HMO GROUP | OTHER | P00066099 | 01 |   | RAILROAD MEDICARE | OTHER | 5231124 | 01 |   | CIGNA HEALTHCARE | OTHER | 010467585001 | 01 |   | ANTHEM BLUE CROSS BLUE SH | OTHER | AA6330 | 01 |   | HARVARD PILGRIM | OTHER | 010467585 | 01 |   | STANDARD TAX ID | OTHER |