Provider Demographics
NPI:1285687632
Name:CORONADO, BORIS E (MD)
Entity Type:Individual
Prefix:DR
First Name:BORIS
Middle Name:E
Last Name:CORONADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N MAITLAND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4499
Mailing Address - Country:US
Mailing Address - Phone:407-660-7150
Mailing Address - Fax:407-660-7108
Practice Address - Street 1:800 N MAITLAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4499
Practice Address - Country:US
Practice Address - Phone:407-660-7150
Practice Address - Fax:407-660-7108
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0072110174400000X
FLME72110207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256399100Medicaid
FL256399100Medicaid
FL46418VMedicare PIN