1609830298 NPI number — MR. GASPARE JOSEPH CORRAO IDC

Table of content: MR. GASPARE JOSEPH CORRAO IDC (NPI 1609830298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609830298 NPI number — MR. GASPARE JOSEPH CORRAO IDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORRAO
Provider First Name:
GASPARE
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
IDC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609830298
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
91-1025 KAIHANUPA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EWA BEACH
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96706-5062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-471-2098
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COMMANDING OFFICER
Provider Second Line Business Practice Location Address:
ATTN: SENIOR MEDICAL DEPARTMENT REPRESENTATIVE
Provider Business Practice Location Address City Name:
FPO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-471-2098
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1710I1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)