Provider Demographics
NPI:1467475988
Name:CIARALLO, ROBERT LUKE
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LUKE
Last Name:CIARALLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 BUTLER ST
Mailing Address - Street 2:P.O. BOX 9507
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15223-2124
Mailing Address - Country:US
Mailing Address - Phone:412-784-0228
Mailing Address - Fax:412-784-0458
Practice Address - Street 1:369 BUTLER ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15223-2124
Practice Address - Country:US
Practice Address - Phone:412-784-0228
Practice Address - Fax:412-784-0458
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1223S0112X1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015472230002Medicaid