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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

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