Provider Demographics
NPI:1134111412
Name:KORVEK, SCOTT JASON (MD, FACEP)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:JASON
Last Name:KORVEK
Suffix:
Gender:M
Credentials:MD, FACEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 OLD YORK RD
Mailing Address - Street 2:KORMAN B-6
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3018
Mailing Address - Country:US
Mailing Address - Phone:215-456-6679
Mailing Address - Fax:
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:KORMAN B-6
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-456-6679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424522207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012661630001Medicaid
PA1012661630003Medicaid
PA1012661630002Medicaid
WV3810011353Medicaid
OH2593368Medicaid
PA091315NJRMedicare PIN
WV3810011353Medicaid
PACG2169Medicare PIN
PAI30336Medicare UPIN
PA1012661630003Medicaid