Provider Demographics
NPI:1508953308
Name:KORANGY, AMILE AZIZOLAH (MD)
Entity Type:Individual
Prefix:DR
First Name:AMILE
Middle Name:AZIZOLAH
Last Name:KORANGY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:13607 SHEEPSHEAD COURT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029
Mailing Address - Country:US
Mailing Address - Phone:410-764-0912
Mailing Address - Fax:410-764-0647
Practice Address - Street 1:6615 REISTERSTOWN RD
Practice Address - Street 2:ATTN: CREDENTIALING
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-2686
Practice Address - Country:US
Practice Address - Phone:410-764-0912
Practice Address - Fax:410-764-0647
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00277042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD460771600Medicaid
MDC87952Medicare UPIN