Healthcare Provider Details

I. General information

NPI: 1225126212
Provider Name (Legal Business Name): DAVID J CORALLO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18586 5TH ST
BELOIT OH
44609-9799
US

IV. Provider business mailing address

18586 5TH ST
BELOIT OH
44609-9799
US

V. Phone/Fax

Practice location:
  • Phone: 330-938-3333
  • Fax: 330-938-9375
Mailing address:
  • Phone: 330-938-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number34006945C
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: