Provider Demographics
NPI:1609081041
Name:BROTZ, COREY STEFAN (MD)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:STEFAN
Last Name:BROTZ
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 1:700 COTTMAN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-1232
Mailing Address - Country:US
Mailing Address - Phone:215-742-9900
Mailing Address - Fax:
Practice Address - Street 1:700 COTTMAN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-1232
Practice Address - Country:US
Practice Address - Phone:215-742-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT185415207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102132146000Medicaid
PA102132146000Medicaid