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NPI Code Detail

MEDICARE: DR. ALBERTO GALLARDO CORRALES M.D.

MEDICARE: DR. ALBERTO GALLARDO CORRALES 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
1208100000XPhysical Medicine & Rehabilitation PhysicianMD441806PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386840510
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALBERTO GALLARDO CORRALES M.D.
Provider Business Mailing Address
First Line : 100 N ACADEMY AVE
Second Line : CREDENTIALS DEPT
City : DANVILLE
State : PA
Zip : 17822-4903
Country : US
Telephone Number : 570-271-6144
Fax Number :
Provider Business Practice Location Address
First Line : 480 CENTRAL RD
Second Line :
City : BLOOMSBURG
State : PA
Zip : 17815-3121
Country : US
Telephone Number : 570-387-6150
Fax Number : 570-387-6185
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2007
Last Update Date : 08/10/2020

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