Healthcare Provider Details

I. General information

NPI: 1528046307
Provider Name (Legal Business Name): CORINNA BALANON SORIANO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 CHURCH HILL RD
NEWTOWN CT
06470-1638
US

IV. Provider business mailing address

32 CHURCH HILL RD
NEWTOWN CT
06470-1638
US

V. Phone/Fax

Practice location:
  • Phone: 203-426-5437
  • Fax: 203-262-4255
Mailing address:
  • Phone: 203-426-5437
  • Fax: 203-262-4255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number045840
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: