Healthcare Provider Details

I. General information

NPI: 1457351330
Provider Name (Legal Business Name): J. GREGORY CORRODI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 MAIN ST SUITE 400
SOUTH WEYMOUTH MA
02190-1868
US

IV. Provider business mailing address

541 MAIN ST SUITE 400
SOUTH WEYMOUTH MA
02190-1868
US

V. Phone/Fax

Practice location:
  • Phone: 781-952-1200
  • Fax: 781-340-1610
Mailing address:
  • Phone: 781-952-1200
  • Fax: 781-340-1610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number76240
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number76240
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: