Provider Demographics
NPI:1487672135
Name:CORRAO, CHERYL ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:CORRAO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:ANN
Other - Last Name:WHITNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:207-384-4949
Mailing Address - Fax:207-384-5700
Practice Address - Street 1:31 COLCORD ST
Practice Address - Street 2:
Practice Address - City:SOUTH BERWICK
Practice Address - State:ME
Practice Address - Zip Code:03908-1004
Practice Address - Country:US
Practice Address - Phone:207-384-4949
Practice Address - Fax:207-384-5700
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-420363AM0700X
NH0402363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3074701Medicaid
ME1487672135Medicaid
NH3074701Medicaid