Provider Demographics
NPI:1457357378
Name:CORALES, ROBERTO B (DO)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:B
Last Name:CORALES
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 1:259 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-3632
Mailing Address - Country:US
Mailing Address - Phone:585-545-7200
Mailing Address - Fax:585-244-6456
Practice Address - Street 1:259 MONROE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-3632
Practice Address - Country:US
Practice Address - Phone:585-545-7200
Practice Address - Fax:585-244-6456
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198349207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02113404Medicaid
H23916Medicare UPIN
NY02113404Medicaid