Basic Information
| Provider Information | |||||||||
| NPI: | 1629316914 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CORPUZ | ||||||||
| FirstName: | VIKTOR | ||||||||
| MiddleName: | LUCAS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 EAST CHESTER PIKE | ||||||||
| Address2: | HAN INTERNAL MEDICINE | ||||||||
| City: | RIDLEY PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190782212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105956586 | ||||||||
| FaxNumber: | 6105956787 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 CHEW ST | ||||||||
| Address2: | SIGAL CENTER | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181023434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107764888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2013 | ||||||||
| LastUpdateDate: | 03/18/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 284502 | NY | N | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | MT203065 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.