Provider Demographics
NPI:1487269767
Name:JEREMY CORBETT MD PLLC
Entity type:Organization
Organization Name:JEREMY CORBETT MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NORIEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-370-9966
Mailing Address - Street 1:5065 WOOSTER RD
Mailing Address - Street 2:LOCKBOX 005818
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1320 MAGAZINE ST STE 203
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-4267
Practice Address - Country:US
Practice Address - Phone:504-370-9966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-13
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty