Provider Demographics
NPI:1518339209
Name:CORELIFE HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:CORELIFE HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:IZZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-975-5447
Mailing Address - Street 1:1111 BENFIELD BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-3005
Mailing Address - Country:US
Mailing Address - Phone:443-679-4309
Mailing Address - Fax:855-772-4748
Practice Address - Street 1:579 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3809
Practice Address - Country:US
Practice Address - Phone:410-975-5447
Practice Address - Fax:888-709-8865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty