Provider Demographics
NPI:1174506836
Name:CORBELLI, RICHARD J (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:CORBELLI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:6255 SHERIDAN DR
Mailing Address - Street 2:SUITE 108 - CREDENTIALING DEPT
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4836
Mailing Address - Country:US
Mailing Address - Phone:716-630-1219
Mailing Address - Fax:716-817-1726
Practice Address - Street 1:295 ESSJAY RD
Practice Address - Street 2:BUFFALO MEDICAL GROUP, PC
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8216
Practice Address - Country:US
Practice Address - Phone:716-630-1146
Practice Address - Fax:716-817-1742
Is Sole Proprietor?:No
Enumeration Date:2005-11-26
Last Update Date:2016-05-20
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Provider Licenses
StateLicense IDTaxonomies
NY154527207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00020526201OtherUNIVERA
NY000511529001OtherBLUE CROSS COMMUNITY BLUE
NY1131644Medicaid
NY2102810OtherINDEPENDENT HEALTH
NY1131644Medicaid
E78927Medicare UPIN