Provider Demographics
NPI:1528046307
Name:BALANON SORIANO, CORINNA (MD)
Entity type:Individual
Prefix:
First Name:CORINNA
Middle Name:
Last Name:BALANON SORIANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CHURCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1638
Mailing Address - Country:US
Mailing Address - Phone:203-426-5437
Mailing Address - Fax:203-262-4255
Practice Address - Street 1:32 CHURCH HILL RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1638
Practice Address - Country:US
Practice Address - Phone:203-426-5437
Practice Address - Fax:203-262-4255
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045840208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400043818Medicare PIN
CTI12011Medicare UPIN