Provider Demographics
NPI:1457351330
Name:CORRODI, J. GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:GREGORY
Last Name:CORRODI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:541 MAIN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1868
Mailing Address - Country:US
Mailing Address - Phone:781-952-1200
Mailing Address - Fax:781-340-1610
Practice Address - Street 1:541 MAIN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1868
Practice Address - Country:US
Practice Address - Phone:781-952-1200
Practice Address - Fax:781-340-1610
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA76240207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA39438OtherFALLON COMMUNITY HEALTH
MA66327OtherHARVARD PILGRIM
MAJ13664OtherBLUE CROSS BLUE SHIELD
MA730784OtherTUFTS HEALTH PLAN
MA0005553OtherNEIGHBORHOOD HEALTH PLAN
MA3107183Medicaid
MA3107183Medicaid
MAJ13664OtherBLUE CROSS BLUE SHIELD
MAJ13664Medicare PIN