Provider Demographics
NPI:1639241995
Name:CORVO, CHRISTINA LOUISE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:LOUISE
Last Name:CORVO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:CHRISTINA
Other - Middle Name:LOUISE
Other - Last Name:CORVO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:200 MILL RD STE 180
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5255
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:
Practice Address - Street 1:300 HANOVER ST STE 3A
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5498
Practice Address - Country:US
Practice Address - Phone:508-973-7770
Practice Address - Fax:508-973-7786
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA2288363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
414004OtherBLUECHIP
0000032417OtherBCBS RI
0000032417OtherBCBS RI
MAP69931Medicare UPIN