Provider Demographics
NPI:1053487587
Name:CORUZZI, MARILYN C (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:C
Last Name:CORUZZI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:MARILYN
Other - Middle Name:CORUZZI
Other - Last Name:WISE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:209 MOLLER AVE
Mailing Address - Street 2:SITKA COMMUNITY HOSPITAL
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-7142
Mailing Address - Country:US
Mailing Address - Phone:907-474-1722
Mailing Address - Fax:907-747-1755
Practice Address - Street 1:209 MOLLER AVE
Practice Address - Street 2:SITKA COMMUNITY HOSPITAL
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-7142
Practice Address - Country:US
Practice Address - Phone:907-474-1722
Practice Address - Fax:907-747-1755
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3781207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD37811Medicaid
B93581Medicare UPIN
AK152872Medicare ID - Type Unspecified