MEDICARE: DR. SANUL CORRIELUS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	MD073627L	PA

General Provider Information

NPI Number	:	1205831716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANUL CORRIELUS MD

Provider Business Mailing Address
First Line	:	628 MANOR RD
Second Line	:
City	:	PENN VALLEY
State	:	PA
Zip	:	19072-1617
Country	:	US
Telephone Number	:	215-383-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	7452 OGONTZ AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19138-1324
Country	:	US
Telephone Number	:	215-383-5900
Fax Number	:	855-777-8654

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	05/30/2025

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