Provider Demographics
NPI:1053371617
Name:LEO I. KOROTKI, M.D.
Entity type:Organization
Organization Name:LEO I. KOROTKI, M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:ISRAEL
Authorized Official - Last Name:KOROTKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-823-9333
Mailing Address - Street 1:21 WEST RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2325
Mailing Address - Country:US
Mailing Address - Phone:410-823-9333
Mailing Address - Fax:410-823-9335
Practice Address - Street 1:21 WEST RD
Practice Address - Street 2:SUITE 105
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-2325
Practice Address - Country:US
Practice Address - Phone:410-823-9333
Practice Address - Fax:410-823-9335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0024017208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD218835OtherALLIANCE
MD5037OtherBLUE CROSS/BLUE SHIELD
MD218835OtherALLIANCE
MD5037Medicare PIN