Basic Information
| Provider Information | |||||||||
| NPI: | 1093977621 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CORRADETTI | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 SPRUCE ST | ||||||||
| Address2: | 1 MALONEY | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191044206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156622200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 805 6TH AVE W | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287394137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286961330 | ||||||||
| FaxNumber: | 8286961075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2008 | ||||||||
| LastUpdateDate: | 06/06/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MT192993 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 2085R0001X | MD441200 | PA | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 254795 | MA | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 2015-02227 | NC | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | NCR270B | 01 | NC | MEDICARE | OTHER |