Provider Demographics
NPI:1902840754
Name:CORSO, THOMAS JOSEPH (PA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOSEPH
Last Name:CORSO
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:111 BREWSTER ST
Mailing Address - Street 2:WOOD BLDG #516
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4400
Mailing Address - Country:US
Mailing Address - Phone:401-729-3481
Mailing Address - Fax:401-729-2721
Practice Address - Street 1:111 BREWSTER ST
Practice Address - Street 2:MEMORIAL HOSPITAL OF RI /DEPT OF SURGERY
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4400
Practice Address - Country:US
Practice Address - Phone:401-729-2241
Practice Address - Fax:401-729-2286
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIPA00311363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI27994-5OtherRI BLUE CROSS ID NUMBER
RITC73054Medicaid
RI9790062661OtherMEDICARE PTAN