Healthcare Provider Details

I. General information

NPI: 1639241995
Provider Name (Legal Business Name): CHRISTINA LOUISE CORVO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA LOUISE CORVO PA-C

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HANOVER ST STE 3A
FALL RIVER MA
02720-5498
US

IV. Provider business mailing address

200 MILL RD STE 180
FAIRHAVEN MA
02719-5255
US

V. Phone/Fax

Practice location:
  • Phone: 508-973-7770
  • Fax: 508-973-7786
Mailing address:
  • Phone: 508-973-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA2288
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier414004
Identifier TypeOTHER
Identifier State
Identifier IssuerBLUECHIP
# 2
Identifier0000032417
Identifier TypeOTHER
Identifier State
Identifier IssuerBCBS RI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: