Provider Demographics
NPI:1568550549
Name:CORALLO, MARCO ROSARIO (DO)
Entity Type:Individual
Prefix:DR
First Name:MARCO
Middle Name:ROSARIO
Last Name:CORALLO
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 1:18586 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:OH
Mailing Address - Zip Code:44609-9799
Mailing Address - Country:US
Mailing Address - Phone:330-938-3333
Mailing Address - Fax:
Practice Address - Street 1:18586 5TH ST
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:OH
Practice Address - Zip Code:44609-9799
Practice Address - Country:US
Practice Address - Phone:330-938-3333
Practice Address - Fax:330-938-9375
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007287207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2176827Medicaid
OH2176827Medicaid
OHG61846Medicare UPIN
OH4036141Medicare PIN