Provider Demographics
NPI:1598805277
Name:CORREALE, DANA M (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:M
Last Name:CORREALE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 AMITY RD
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:CT
Mailing Address - Zip Code:06524-3430
Mailing Address - Country:US
Mailing Address - Phone:203-393-8881
Mailing Address - Fax:
Practice Address - Street 1:677 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3158
Practice Address - Country:US
Practice Address - Phone:203-250-7577
Practice Address - Fax:203-250-0739
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045099207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology