Provider Demographics
NPI:1952695207
Name:CORRADETTI, ANITA (MD)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:CORRADETTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:
Other - Last Name:ABHYANKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:115 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6358
Mailing Address - Country:US
Mailing Address - Phone:508-383-1479
Mailing Address - Fax:508-383-8537
Practice Address - Street 1:336 BON AIR CTR STE 427
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-3017
Practice Address - Country:US
Practice Address - Phone:415-925-7545
Practice Address - Fax:415-925-7008
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-00038207R00000X
MA257413207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine