Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DS-023644-L | PA |
NPI | 1093889768 |
---|---|
Provider Name | Dr. Gregg M Corsello |
First Address | Pittsburgh, PA 15237-3414 |
Second Address | Pittsburgh, PA 15237-3414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 08/07/2007 |