Basic Information
| Provider Information | |||||||||
| NPI: | 1215924758 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORCORAN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | F.T. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2006 BREMO RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232262438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042881881 | ||||||||
| FaxNumber: | 8042826413 | ||||||||
| Practice Location | |||||||||
| Address1: | 2006 BREMO RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232262438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042881881 | ||||||||
| FaxNumber: | 8042826413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2005 | ||||||||
| LastUpdateDate: | 06/12/2013 | ||||||||
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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 | 2084A0401X | 0101033266 | VA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | 2084P0800X | 0101033266 | VA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 007198485 | 05 | VA | MEDICAID |