Basic Information
| Provider Information | |||||||||
| NPI: | 1902816861 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CORRADO | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 COMMUNICATIONS WAY | ||||||||
| Address2: | MACC - REVENUE CYCLE | ||||||||
| City: | HYANNIS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026011866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089578664 | ||||||||
| FaxNumber: | 5089578677 | ||||||||
| Practice Location | |||||||||
| Address1: | 21 BRAMBLEBUSH PARK | ||||||||
| Address2: | BRAMBLEBUSH MEDICAL GROUP | ||||||||
| City: | FALMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084955160 | ||||||||
| FaxNumber: | 5084955170 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 04/23/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 038033 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 231310 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001380336 | 05 | CT | MEDICAID |