Provider Demographics
NPI:1568463784
Name:FIORELLI, ROBERT L (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:FIORELLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 RTE. 315
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-6928
Mailing Address - Country:US
Mailing Address - Phone:570-820-3320
Mailing Address - Fax:570-820-3388
Practice Address - Street 1:670 S RIVER ST STE 301
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-1032
Practice Address - Country:US
Practice Address - Phone:570-270-2600
Practice Address - Fax:570-270-2828
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005553L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010930870Medicaid
PA608712OtherFIRST PRIORITY LIFE
PA35740OtherGEISINGER HEALTH PLAN
PA4399736OtherAETNA
PA608712OtherHIGHMARK BLUE SHIELD
PA822570OtherFIRST PRIORITY HEALTH
PA4399736OtherAETNA
PA608712XQNMedicare PIN