Organization
DAVID J CORALLO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA D. EDWARDS (OFFICE MANAGER)
(330) 938-3333
Entity
Organization
Contact information
Practice address
18586 5TH ST, BELOIT, OH 44609-9799
(330) 938-3333
(330) 938-9375
Mailing address
18586 5TH ST, BELOIT, OH 44609-9799
(330) 938-3333
(330) 938-9375
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
34006945C
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2241425
—
OH
01
—
DG3616
RAILROAD MEDICARE
OH
Enumeration date
10/18/2007
Last updated
05/15/2025
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