Healthcare Provider Details

I. General information

NPI: 1770624058
Provider Name (Legal Business Name): MARCO R. CORALLO, D.O., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 02/11/2016
Certification Date:
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: 330-938-9375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number34007287
License Number StateOH

VIII. Authorized Official

Name: ANGELA LAMBDIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 330-938-3333