Provider Demographics
NPI:1477754687
Name:KOREN, DORIT (MD)
Entity Type:Individual
Prefix:DR
First Name:DORIT
Middle Name:
Last Name:KOREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:YAWKEY BUILDING, SUITE 6C
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-726-2909
Mailing Address - Fax:617-724-0581
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:YAWKEY BUILDING, SUITE 6C
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-2909
Practice Address - Fax:617-724-0581
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428754208000000X
IL036.1306642080P0205X, 2080P0205X
MA2692422080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400347271Medicare PIN