Provider Demographics
NPI:1609830298
Name:CORRAO, GASPARE JOSEPH (IDC)
Entity Type:Individual
Prefix:MR
First Name:GASPARE
Middle Name:JOSEPH
Last Name:CORRAO
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1025 KAIHANUPA ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-5062
Mailing Address - Country:US
Mailing Address - Phone:808-471-2098
Mailing Address - Fax:
Practice Address - Street 1:COMMANDING OFFICER
Practice Address - Street 2:ATTN: SENIOR MEDICAL DEPARTMENT REPRESENTATIVE
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96674
Practice Address - Country:US
Practice Address - Phone:808-471-2098
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman