Individual
COREY CARACCIOLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 334-0605
(508) 856-5074
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA8113
MA
363A00000X
Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/03/2019
Last updated
06/29/2021
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