Provider Demographics
NPI:1326021312
Name:CORBELLI, JOHN C (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:CORBELLI
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 1:6460 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5838
Mailing Address - Country:US
Mailing Address - Phone:716-634-5100
Mailing Address - Fax:716-634-5134
Practice Address - Street 1:6460 MAIN ST
Practice Address - Street 2:BUFFALO CARDIOLOGY & PULMANARY ASSOC PC
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5838
Practice Address - Country:US
Practice Address - Phone:716-634-5100
Practice Address - Fax:716-634-5134
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142481207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2101795OtherINDEPENDENT HEALTH
NY000510052001OtherBLUECROSS COMMUNITY BLUE
NY989473Medicaid
NY00010035901OtherUNIVERA
NY00010035901OtherUNIVERA
B70978Medicare UPIN