Provider Demographics
NPI:1073576542
Name:SURGEON, CORAL L (MD)
Entity Type:Individual
Prefix:
First Name:CORAL
Middle Name:L
Last Name:SURGEON
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 1:1815 CLINTON AVE S
Mailing Address - Street 2:SUITE 610
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5720
Mailing Address - Country:US
Mailing Address - Phone:585-244-3430
Mailing Address - Fax:
Practice Address - Street 1:1815 S CLINTON AVE
Practice Address - Street 2:SUITE 610
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5720
Practice Address - Country:US
Practice Address - Phone:585-244-3430
Practice Address - Fax:585-244-7811
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157602207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010157602OtherBLUE CHOICE
NY0296919OtherGHI
NY000914977001OtherBC/BS OF WESTERN NEW YORK
NY6184OtherBC/BS
NY000914977003OtherBC/BS OF WESTERN NEW YORK
NY00849803Medicaid
NY102458CKOtherPREFERRED CARE
NY160009306OtherRAILROAD
NY7849236OtherAETNA
NY000914977002OtherBC/BS OF WESTERN NEW YORK
NY6184OtherBC/BS
NY000914977003OtherBC/BS OF WESTERN NEW YORK