Provider Demographics
NPI:1154387280
Name:CORKUM, JAMES MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:CORKUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:515 FAIRMOUNT AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-8518
Mailing Address - Country:US
Mailing Address - Phone:410-494-1315
Mailing Address - Fax:410-494-1361
Practice Address - Street 1:515 FAIRMOUNT AVE STE 100A
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-8520
Practice Address - Country:US
Practice Address - Phone:410-494-1315
Practice Address - Fax:410-584-2244
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD34084207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD069571800Medicaid
MD100007250Medicare PIN
MD157676Medicare PIN
MDE56049Medicare UPIN
MD730LMedicare PIN
MD069571800Medicaid