Prudencio C Corro, MD

Primary specialty

Otolaryngic Allergy PhysicianTaxonomy code 207YX0602X

License

9578 Issued in WV

Practice address

673 Ritter Dr
Glen Morgan, WV 25813-7707

Phone

(304) 252-0775

Fax

(304) 255-6688

NPI assigned

May 4, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• P.C. Corro M.D., Inc

  • Specialist
  • Beckley, WV
  • NPI 1861575839
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607299200000",
    "number": "1740238765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "673 RITTER DR",
            "city": "GLEN MORGAN",
            "state": "WV",
            "postal_code": "258137707",
            "telephone_number": "304-252-0775",
            "fax_number": "304-255-6688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "673 RITTER DR",
            "city": "GLEN MORGAN",
            "state": "WV",
            "postal_code": "258137707",
            "telephone_number": "304-252-0775",
            "fax_number": "304-255-6688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORRO",
        "first_name": "PRUDENCIO",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2020-12-07",
        "certification_date": "2020-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "WV",
            "license": "5862",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "WV",
            "license": "9578",
            "primary": false
        },
        {
            "code": "207YX0602X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngic Allergy",
            "state": "WV",
            "license": "9578",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0101068000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anthony Bragg
• Carol Bryant
• Sarah Burks
• Bypass Pharmacy Inc
• Elizabeth Mary Cormack, OTR L
• Samantha Cozart
• Regina Lynn Croto
• Ann Darby
• Virginia Ann Dodge
• Suzanne Holt Elliott, M.A.

• Otolaryngology Physician in Glen Morgan, WV
• Providers in Glen Morgan, WV by specialty
• Otolaryngology Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.