Provider Demographics
NPI:1417947847
Name:KORN, STEPHEN JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JAMES
Last Name:KORN
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 1:37 JUNIPER RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-3223
Mailing Address - Country:US
Mailing Address - Phone:781-718-0189
Mailing Address - Fax:781-784-3491
Practice Address - Street 1:37 JUNIPER RD
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-3223
Practice Address - Country:US
Practice Address - Phone:781-718-0189
Practice Address - Fax:781-784-3491
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77338207L00000X
RIMD10945207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RISK22647Medicaid
MA778415OtherTUFTS HEALTH PLAN
MAJ17658OtherBCBS MA
MA3191761Medicaid
F20616Medicare UPIN
RISK22647Medicaid
MAA22596Medicare PIN