Provider Demographics
NPI:1316962491
Name:CORSELLO, BRUCE FRANCIS (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:FRANCIS
Last Name:CORSELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 GOODMAN ST S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-3105
Mailing Address - Country:US
Mailing Address - Phone:585-271-2755
Mailing Address - Fax:585-271-7358
Practice Address - Street 1:300 GOODMAN ST S
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-3105
Practice Address - Country:US
Practice Address - Phone:585-271-2755
Practice Address - Fax:585-271-7358
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145625207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01029616Medicaid
NY100936AAOtherPREFERRED CARE
NY11403CMedicare ID - Type UnspecifiedMEDICARE
NY01029616Medicaid