Provider Demographics
NPI:1023068962
Name:BECK CORSELLO, MARY ANN (PA)
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:BECK CORSELLO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:525 OKEECHOBEE BLVD
Mailing Address - Street 2:CITY TOWER PLACE 14TH FLOOR
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-6349
Mailing Address - Country:US
Mailing Address - Phone:561-804-0200
Mailing Address - Fax:561-804-0222
Practice Address - Street 1:525 OKEECHOBEE BLVD
Practice Address - Street 2:CITY TOWER PLACE 14TH FLOOR
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-6349
Practice Address - Country:US
Practice Address - Phone:561-804-0200
Practice Address - Fax:561-804-0222
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9106112363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000502699OtherANTHEM BC/BS
FLY0F7COtherBCBS
FL1023068962OtherTRICARE
FL364100OtherAV MED
S79968Medicare UPIN
OHPA80611Medicare PIN
OH000000502699OtherANTHEM BC/BS
FL364100OtherAV MED