Provider Demographics
NPI:1689907859
Name:KORMAN, BENJAMIN DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:DOUGLAS
Last Name:KORMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE BOX MED
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-784-9842
Mailing Address - Fax:585-427-8718
Practice Address - Street 1:125 LATTIMORE RD STE G-110
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4159
Practice Address - Country:US
Practice Address - Phone:585-486-0901
Practice Address - Fax:585-340-5399
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-04
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILAN52403949533207R00000X
NY291476207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine