Individual
DIANE M CORALLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
485 ROYER DR STE 103, LANCASTER, PA 17601-5102
(717) 560-4020
(717) 560-2919
Mailing address
485 ROYER DR, SUITE 103, LANCASTER, PA 17601-5102
(717) 397-8259
(717) 397-1786
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
MD042035E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000646989
—
PA
05
—
0012571430001
—
PA
01
—
37812
BLUE SHIELD
PA
Enumeration date
07/29/2005
Last updated
12/08/2020
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