Provider Demographics
NPI:1174574867
Name:CORCINO, BALTAZAR L (MD)
Entity type:Individual
Prefix:DR
First Name:BALTAZAR
Middle Name:L
Last Name:CORCINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:809 TURNPIKE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-1232
Mailing Address - Country:US
Mailing Address - Phone:814-768-2356
Mailing Address - Fax:814-768-2134
Practice Address - Street 1:531 HANNAH ST
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-1209
Practice Address - Country:US
Practice Address - Phone:814-765-1982
Practice Address - Fax:814-765-8213
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD031136L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006187790004Medicaid
PA0006187790005Medicaid
PAB39245Medicare UPIN
PA0006187790004Medicaid