Healthcare Provider Details

I. General information

NPI: 1679735567
Provider Name (Legal Business Name): JOSE MARIA CORREA, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 MAIN ST SUITE 101
NORTHBOROUGH MA
01532-1914
US

IV. Provider business mailing address

112 MAIN ST SUITE 101
NORTHBOROUGH MA
01532-1914
US

V. Phone/Fax

Practice location:
  • Phone: 508-393-7807
  • Fax: 508-393-8608
Mailing address:
  • Phone: 508-393-7807
  • Fax: 508-393-8608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSE MARIA CORREA
Title or Position: PEDIATRICIAN
Credential: M.D.
Phone: 508-393-7807