Provider Demographics
NPI:1679685259
Name:KORKUT, EDIB (MD)
Entity Type:Individual
Prefix:
First Name:EDIB
Middle Name:
Last Name:KORKUT
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 1:4977 BATTERY LN
Mailing Address - Street 2:317
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4931
Mailing Address - Country:US
Mailing Address - Phone:301-215-4877
Mailing Address - Fax:
Practice Address - Street 1:2495 SHREVEPORT HIGHWAY
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:IA
Practice Address - Zip Code:71306
Practice Address - Country:US
Practice Address - Phone:318-473-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013119207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F34963Medicare UPIN