Provider Demographics
NPI:1760562433
Name:CORREA SARDINA, NORBERT (MD)
Entity Type:Individual
Prefix:
First Name:NORBERT
Middle Name:
Last Name:CORREA SARDINA
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:BAYAMON MEDICAL MALL
Mailing Address - Street 2:SUITE 709
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-7200
Mailing Address - Country:US
Mailing Address - Phone:787-919-7855
Mailing Address - Fax:787-288-9911
Practice Address - Street 1:BAYAMON MEDICAL MALL
Practice Address - Street 2:SUITE 709
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7200
Practice Address - Country:US
Practice Address - Phone:787-919-7855
Practice Address - Fax:787-288-9911
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15705207R00000X
PRDEA BC9442649207R00000X
PRDM-15863-4207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR23971Medicare ID - Type Unspecified
I51105Medicare UPIN