MEDICARE: ROBERT RICCARDO CORRATO M.D.

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	207R00000X	Internal Medicine Physician	MD055543L	PA

General Provider Information

NPI Number	:	1003827072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT RICCARDO CORRATO M.D.

Provider Business Mailing Address
First Line	:	15 CAMPUS BLVD
Second Line	:	SUITE 200
City	:	NEWTOWN SQUARE
State	:	PA
Zip	:	19073-3200
Country	:	US
Telephone Number	:	484-454-6268
Fax Number	:	610-789-6158

Provider Business Practice Location Address
First Line	:	15 CAMPUS BLVD
Second Line	:	SUITE 200
City	:	NEWTOWN SQUARE
State	:	PA
Zip	:	19073-3200
Country	:	US
Telephone Number	:	484-454-6268
Fax Number	:	610-789-6158

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	07/08/2007

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