Provider Demographics
NPI:1124413844
Name:KORZAN, SOPHIE
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:
Last Name:KORZAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 WILKENS AVE STE 440
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5073
Mailing Address - Country:US
Mailing Address - Phone:410-644-3890
Mailing Address - Fax:410-644-6517
Practice Address - Street 1:3407 WILKENS AVE STE 440
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5073
Practice Address - Country:US
Practice Address - Phone:410-644-3890
Practice Address - Fax:410-644-6517
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT061359207R00000X
MDD95147207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine