Healthcare Provider Details

I. General information

NPI: 1366409526
Provider Name (Legal Business Name): DEYANINA CORZO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

10 ROGERS ST APT 1101
CAMBRIDGE MA
02142-1246
US

V. Phone/Fax

Practice location:
  • Phone: 617-768-6926
  • Fax:
Mailing address:
  • Phone: 617-494-1891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number208008
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number208008
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: