Provider Demographics
NPI:1861478091
Name:CORONEOS, EMMANOUEL J (MD)
Entity Type:Individual
Prefix:
First Name:EMMANOUEL
Middle Name:J
Last Name:CORONEOS
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 1:372 N CRAIG ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-1245
Mailing Address - Country:US
Mailing Address - Phone:412-683-7560
Mailing Address - Fax:412-683-6992
Practice Address - Street 1:372 N CRAIG ST STE 101
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-1245
Practice Address - Country:US
Practice Address - Phone:412-683-7560
Practice Address - Fax:412-683-6992
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-072907-L207RN0300X
WV20507207RN0300X
PAMD072907L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018374200001Medicaid
WV3002230000Medicaid
WV3002230000Medicaid
PA046647JEDMedicare PIN
WVC04053212Medicare UPIN
WVCO4053212Medicare PIN
PA046647JEDMedicare UPIN