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General NPI Number Information
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NPI Number | 1265412951
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Entity Type | Individual
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Provider Name | ANDREW C CORSELLO M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 96 CAMPUS DR SUITE 1
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City | SCARBOROUGH
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State | ME
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Zip | 04074-7133
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Country | US
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Telephone | 207-396-5611
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Fax |
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Provider Business Mailing Address
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Address Line | 301C US ROUTE 1
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City | SCARBOROUGH
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State | ME
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Zip | 04074-9701
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Country | US
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Telephone | 207-396-8600
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Fax | 207-396-8632
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MD15604
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | MD15604
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License Number State | ME
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