1033158308 NPI number — DR. CHARLES HARRIS KORMAN DO

Table of content: DR. CHARLES HARRIS KORMAN DO (NPI 1033158308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033158308 NPI number — DR. CHARLES HARRIS KORMAN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KORMAN
Provider First Name:
CHARLES
Provider Middle Name:
HARRIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1033158308
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 HUNTINGDON PIKE
Provider Second Line Business Mailing Address:
100
Provider Business Mailing Address City Name:
ROCKLEDGE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19046-4338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-663-8880
Provider Business Mailing Address Fax Number:
215-663-8898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 HUNTINGDON PIKE
Provider Second Line Business Practice Location Address:
100
Provider Business Practice Location Address City Name:
ROCKLEDGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19046-4338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-663-8880
Provider Business Practice Location Address Fax Number:
215-663-8898
Provider Enumeration Date:
06/05/2006

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:  OS013667 , 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: 1894024 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1464152 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 597586 . This is a "MEDICARE GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00416093 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3Y7846 . This is a "HEALTH NET" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 15793 . This is a "BRAVO HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30041231 . This is a "KMHP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 450204 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7554880 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2760579000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 101713292 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30043529 . This is a "KMHP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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