Individual
CORALLI R SO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
585 LEBANON ST, RADIOLOGY DEPARTMENT, MELROSE, MA 02176-3225
(781) 979-3120
(781) 979-3994
Mailing address
244 W NEWTON ST, APARTMENT #3, BOSTON, MA 02116-6405
(781) 979-3120
(781) 979-3994
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
152261
MA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
152261
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0196321
—
MA
Enumeration date
06/16/2006
Last updated
07/05/2016
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