Provider Demographics
NPI:1326001504
Name:KORT, HENRY WARREN (MD)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:WARREN
Last Name:KORT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 CHESTNUT ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:50 WASON AVE FL 1
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1280
Practice Address - Country:US
Practice Address - Phone:413-794-5437
Practice Address - Fax:413-794-7408
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL80972080P0202X
MA10165842080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166222301Medicaid
LA1632490Medicaid
TX0099AZOtherMEDICARE GROUP #
TX10013283OtherAMERIGROUP PROVIDER #
TX8K8792OtherBCBS PROVIDER #
OK200015490AMedicaid
TX094999202OtherMEDICAID GROUP #
TX3231HMOtherBCBS GROUP #