Healthcare Provider Details

I. General information

NPI: 1366569220
Provider Name (Legal Business Name): MANUEL CORREIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 HIGHLAND AVE
FALL RIVER MA
02720-3703
US

IV. Provider business mailing address

29 BENTLEY LN
WESTPORT MA
02790-2221
US

V. Phone/Fax

Practice location:
  • Phone: 508-679-7041
  • Fax:
Mailing address:
  • Phone: 508-673-2915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number209985
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: