Provider Demographics
NPI:1912995507
Name:CORELLI, RICHARD J (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:CORELLI
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:943 MIDDLEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-3339
Mailing Address - Country:US
Mailing Address - Phone:650-326-1915
Mailing Address - Fax:650-726-2594
Practice Address - Street 1:943 MIDDLEFIELD RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-3339
Practice Address - Country:US
Practice Address - Phone:650-326-1915
Practice Address - Fax:650-726-2594
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG325032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA45172Medicare UPIN