Provider Demographics
NPI:1205044419
Name:KORGAONKAR, SONAL NAVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:SONAL
Middle Name:NAVIN
Last Name:KORGAONKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SONAL
Other - Middle Name:NAVIN
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1589 SULPHUR SPRING RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-2542
Mailing Address - Country:US
Mailing Address - Phone:410-536-5400
Mailing Address - Fax:410-737-2168
Practice Address - Street 1:25 CROSSROADS DR
Practice Address - Street 2:SUITE 205
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5421
Practice Address - Country:US
Practice Address - Phone:410-602-7792
Practice Address - Fax:410-602-9889
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD69862207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD028712100Medicaid
MD176265Y56OtherMEDICARE PTAN