Provider Demographics
NPI:1790779643
Name:MORELLO, ROBERT STEPHEN (MD, PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:STEPHEN
Last Name:MORELLO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3204
Mailing Address - Country:US
Mailing Address - Phone:607-734-2984
Mailing Address - Fax:607-398-3411
Practice Address - Street 1:207 MADISON AVE
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-3204
Practice Address - Country:US
Practice Address - Phone:607-734-2984
Practice Address - Fax:607-398-3411
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161637207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180000141OtherRR MEDICARE
E96199Medicare UPIN