M D Corgiat PA

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6344743-2501 Issued in UT

Legal business name

M D CORGIAT PA

Practice address

3903 Harrison Blvd
Suite 305
Ogden, UT 84403-2314

Phone

(801) 387-3807

Fax

(801) 387-3810

NPI assigned

Feb 21, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark David Corgiat, PH.D.

Title

Owner,Director

Phone

(801) 621-6100

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Mark D. Corgiat, Ph.D. Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Damon Christopher Corgiat, PH.D.

  • Clinical Psychologist
  • Riverside, CA
  • NPI 1205223849
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1203552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283472000000",
    "number": "1750550075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3903 HARRISON BLVD",
            "address_2": "SUITE 305",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844032314",
            "telephone_number": "801-387-3807",
            "fax_number": "801-387-3810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3903 HARRISON BLVD",
            "address_2": "SUITE 305",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844032314",
            "telephone_number": "801-387-3807",
            "fax_number": "801-387-3810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M D CORGIAT PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-21",
        "last_updated": "2010-09-03",
        "status": "A",
        "authorized_official_last_name": "CORGIAT",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER,DIRECTOR",
        "authorized_official_telephone_number": "801-621-6100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "UT",
            "license": "6344743-2501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL NPI",
            "identifier": "1336296003",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1336296003",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mark D. Corgiat, Ph.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• John H Lyons III, MD
• Vicki J Lyons, M.D.
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• Rodolfo G Madlang, MD
• Michelle Madrigal

• Clinical Psychologist in Ogden, UT
• Providers in Ogden, UT by specialty
• Clinical Psychologist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.