Provider Demographics
NPI:1124219589
Name:KORNBLUTH, JOSHUA ARI (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:ARI
Last Name:KORNBLUTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:800 WASHINGTON ST
Mailing Address - Street 2:BOX 314
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1552
Mailing Address - Country:US
Mailing Address - Phone:617-636-5854
Mailing Address - Fax:617-636-8199
Practice Address - Street 1:800 WASHINGTON ST
Practice Address - Street 2:BOX 314
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1552
Practice Address - Country:US
Practice Address - Phone:617-636-5854
Practice Address - Fax:617-636-8199
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2554372084N0400X, 2084A2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology