Provider Demographics
NPI:1063025070
Name:KORCHEMNY, NIKOLAY (MD)
Entity Type:Individual
Prefix:
First Name:NIKOLAY
Middle Name:
Last Name:KORCHEMNY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:KORCHEMNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:736 CAMBRIDGE STREET
Mailing Address - Street 2:OFFICE OF GME
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135
Mailing Address - Country:US
Mailing Address - Phone:617-789-2386
Mailing Address - Fax:
Practice Address - Street 1:736 CAMBRIDGE STREET
Practice Address - Street 2:OFFICE OF GME
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:617-789-2386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA284966207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine