Provider Demographics
NPI:1902816861
Name:CORRADO, SUZANNE A (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:A
Last Name:CORRADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 COMMUNICATIONS WAY
Mailing Address - Street 2:MACC - REVENUE CYCLE
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-1866
Mailing Address - Country:US
Mailing Address - Phone:508-957-8664
Mailing Address - Fax:508-957-8677
Practice Address - Street 1:21 BRAMBLEBUSH PARK
Practice Address - Street 2:BRAMBLEBUSH MEDICAL GROUP
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540
Practice Address - Country:US
Practice Address - Phone:508-495-5160
Practice Address - Fax:508-495-5170
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038033207R00000X
MA231310207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001380336Medicaid
CT001380336Medicaid
CT110007704Medicare ID - Type Unspecified