1326067778 NPI number — NEIL J KORMAN MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326067778 NPI number — NEIL J KORMAN MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KORMAN

Provider First Name:

NEIL

Provider Middle Name:

J

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1326067778

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/05/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

20800 HARVARD RD

Provider Second Line Business Mailing Address:

2ND FLR

Provider Business Mailing Address City Name:

HIGHLAND HILLS

Provider Business Mailing Address State Name:

OH

Provider Business Mailing Address Postal Code:

44122-7251

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

11100 EUCLID AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

CLEVELAND

Provider Business Practice Location Address State Name:

OH

Provider Business Practice Location Address Postal Code:

44106-1716

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

216-844-8200

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

07/18/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207N00000X , with the licence number:  35-052621 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207NI0002X , with the licence number: 35-052621 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 000000523165 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 0782078 . This is a "BCMH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 0782078 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: P00406580 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 000000140399 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 742146 . This is a "BUCKEYE" identifier . This identifiers is of the category "OTHER".
• Identifier: 1052221 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 363719 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 70013560 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 000000221045 . This is a "UNISON" identifier . This identifiers is of the category "OTHER".