1316950132 NPI number — DR. MICHAEL J KORMAN M.D.

Table of content: (NPI 1689795692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316950132 NPI number — DR. MICHAEL J KORMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KORMAN
Provider First Name:
MICHAEL
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316950132
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1503 LANSDOWNE AVE
Provider Second Line Business Mailing Address:
SUITE 3007
Provider Business Mailing Address City Name:
DARBY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19023-1330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-534-6140
Provider Business Mailing Address Fax Number:
610-534-6144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1503 LANSDOWNE AVE
Provider Second Line Business Practice Location Address:
SUITE 3007
Provider Business Practice Location Address City Name:
DARBY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19023-1330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-534-6140
Provider Business Practice Location Address Fax Number:
610-534-6144
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD028037E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X , with the licence number: MD028037E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: MD028037E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 516335 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0111471209 . This is a "AMERICHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 290002553 . This is a "PALMETTO RAILROAD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 516335 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0110914000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 31903B . This is a "KEYSTONE MERCY HEALTH PLN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0011147120001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2Y5711 . This is a "ELDERHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 516335 . This is a "CIGNA INS CO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7936907 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: DES139 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: E64186 . This is a "SENIORPARTNERS HEALTHPART" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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