Individual
DR. AUGUSTO C. CORELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4660 KENMORE AVE, SUITE 710, ALEXANDRIA, VA 22304-1313
(703) 370-9002
(703) 370-2849
Mailing address
4660 KENMORE AVE, SUITE 710, ALEXANDRIA, VA 22304-1313
(703) 370-9002
(703) 370-2849
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101239903
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019567106
MEDICARE PTAN
—
Enumeration date
08/18/2005
Last updated
02/12/2021
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