Provider Demographics
NPI:1356471999
Name:CORSALE, MARK JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAMES
Last Name:CORSALE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2900 WEST PROSPECT ROAD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30332-5839
Mailing Address - Country:US
Mailing Address - Phone:404-894-2585
Mailing Address - Fax:
Practice Address - Street 1:2900 W PROSPECT RD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-2519
Practice Address - Country:US
Practice Address - Phone:954-731-1000
Practice Address - Fax:954-731-1000
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD121322084P0800X
FLME580872084P0800X
GA0565322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCB924774241Medicare UPIN