Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | MD15604 | ME |
NPI | 1265412951 |
---|---|
Provider Name | Andrew C Corsello |
First Address | Scarborough, ME 04074-9701 |
Second Address | Scarborough, ME 04074-7133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 17/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
295850099 | (05) | ME |
G45643 | (02) | ME |
P00816540 | RR MEDICARE (01) | ME |