Provider Demographics
NPI:1740304419
Name:CORONATO, ERIC EDWARD (DO)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:EDWARD
Last Name:CORONATO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:101 E WOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-585-8221
Practice Address - Fax:864-542-9859
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC90972208800000X
FLOS10889208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP307802OtherFREEDOM HEALTH
SC909726Medicaid
FL1192983OtherWELLCARE
FL339734OtherAVMED
FL5838598OtherCIGNA
FLP204013OtherFREEDOM HEALTH OPTIMUM
FL002482900Medicaid
FL37549OtherUNIVERSAL HEALTHCARE
FL1669024OtherGHI
FLP00868014OtherRAILROAD MEDICARE
SCSCS3913365OtherMEDICARE PIN
FL148WTOtherBCBS FL
FLP01776636OtherCLEAR HEALTH ALLIANCE