Provider Demographics
NPI:1326067778
Name:KORMAN, NEIL J (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:J
Last Name:KORMAN
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 1:20800 HARVARD RD
Mailing Address - Street 2:2ND FLR
Mailing Address - City:HIGHLAND HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7251
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-052621207N00000X, 207NI0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000523165OtherANTHEM
OH0782078OtherBCMH
OH0782078Medicaid
OHP00406580OtherRAILROAD MEDICARE
OH000000140399OtherANTHEM
742146OtherBUCKEYE
OH1052221OtherAETNA
363719OtherWELLCARE
OH70013560OtherRAILROAD MEDICARE
000000221045OtherUNISON
OHKO0665682Medicare PIN
OHKO0665688Medicare PIN
OH1052221OtherAETNA