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Benjamin M Corcoran
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NPI Number Detailed Information
Provider Information:
| Name: | Benjamin M Corcoran |
| Gender: | M |
| Provider License Number If Given: | 040-0003806 |
NPI Information:
| NPI: | 1083609531 |
| Entity Type (Individual or Organization): |
1-ind |
| Enumeration Date: | 9/12/2005 |
| Last Update Date: | 12/6/2012 |
Provider Business Mailing Address:
| Address: | 115 WELLNESS DR Williston, VT 05495 |
| Phone Number: | 8028601358 |
| Fax Number: | 8028601093 |
Provider Business Practice Location Address:
| Address: | 115 WELLNESS DR Williston, VT 05495 |
| Phone Number: | 8028601358 |
| Fax Number: | 8028601093 |
Provider Taxonomy:
| Primary: | 225100000X |
| Secondary (if any): | 225100000X |
| State: | VT |
