Provider Demographics
NPI:1235118407
Name:KORENYI-BOTH, ILDIKO
Entity Type:Individual
Prefix:DR
First Name:ILDIKO
Middle Name:
Last Name:KORENYI-BOTH
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 1:551 W LANCASTER AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041-1419
Mailing Address - Country:US
Mailing Address - Phone:610-520-5200
Mailing Address - Fax:610-520-1998
Practice Address - Street 1:551 W LANCASTER AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041-1419
Practice Address - Country:US
Practice Address - Phone:610-520-5200
Practice Address - Fax:610-520-1998
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-038438-L207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B35280Medicare UPIN
PA084087HK1Medicare ID - Type UnspecifiedGREAT VALLEY HEALTH