Provider Demographics
NPI:1346574753
Name:RATHNAM, CORINNE A (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:CORINNE
Middle Name:A
Last Name:RATHNAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4623 FOREST HILL BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-7469
Mailing Address - Country:US
Mailing Address - Phone:561-969-7900
Mailing Address - Fax:561-969-7919
Practice Address - Street 1:4623 FOREST HILL BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-7469
Practice Address - Country:US
Practice Address - Phone:561-969-7900
Practice Address - Fax:561-969-7919
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9104800207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9104800OtherSTATE LICENSE NUMBER