Healthcare Provider Details

I. General information

NPI: 1558597906
Provider Name (Legal Business Name): CORINNE L PUZIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 VILLAGE SQ
CHELMSFORD MA
01824-2712
US

IV. Provider business mailing address

31 VILLAGE SQ
CHELMSFORD MA
01824-2712
US

V. Phone/Fax

Practice location:
  • Phone: 978-256-9507
  • Fax:
Mailing address:
  • Phone: 978-256-9507
  • Fax: 615-261-6052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number278196
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: