Provider Demographics
NPI:1366409526
Name:CORZO, DEYANINA (MD)
Entity type:Individual
Prefix:DR
First Name:DEYANINA
Middle Name:
Last Name:CORZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ROGERS ST
Mailing Address - Street 2:APT 1101
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02142-1246
Mailing Address - Country:US
Mailing Address - Phone:617-494-1891
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-768-6926
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208008207SG0201X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA125091Medicaid