Provider Demographics
NPI:1164635496
Name:KORNHAUSER, MICHAEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:KORNHAUSER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:111 S 11TH ST
Practice Address - Street 2:THOMAS JEFFERSON UNIVERSITY HOSPITAL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4824
Practice Address - Country:US
Practice Address - Phone:215-955-8346
Practice Address - Fax:215-955-9989
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2011-09-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD026834E2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01047692Medicaid
PA01047692Medicaid