Provider Demographics
NPI:1992788566
Name:MCCORVEY, VIVIAN MONIQUE (MD)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:MONIQUE
Last Name:MCCORVEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7304 E DEER VALLEY RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-7450
Mailing Address - Country:US
Mailing Address - Phone:602-651-1901
Mailing Address - Fax:602-749-8613
Practice Address - Street 1:559 ABBOTT ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4325
Practice Address - Country:US
Practice Address - Phone:831-775-5200
Practice Address - Fax:831-796-3891
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY396402085R0202X
AZ410202085R0202X
CA535652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ398236Medicaid
KY64105000Medicaid
KY64105000Medicaid
AZZ124793Medicare PIN
KY0943423Medicare ID - Type Unspecified
AZ398236Medicaid