Provider Demographics
NPI:1730134461
Name:KORNBLATT, BRIAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:KORNBLATT
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 1:5 EXECUTIVE CIR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3345
Mailing Address - Country:US
Mailing Address - Phone:912-355-2400
Mailing Address - Fax:912-355-5324
Practice Address - Street 1:5 EXECUTIVE CIR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3345
Practice Address - Country:US
Practice Address - Phone:912-355-2400
Practice Address - Fax:912-355-5324
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038029207P00000X
SC20004207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000594624BMedicaid
GA000594624QMedicaid
GA000594624TMedicaid
GA000594624UMedicaid
GA000594624HMedicaid
GA000594624FMedicaid
SC000594624RMedicaid
GA000594624DMedicaid
GA000594624SMedicaid
SCP00176380Medicare PIN
GA000594624UMedicaid
GA93BDQSGMedicare PIN
GA93BBFBJMedicare PIN
GA000594624FMedicaid
GA000594624QMedicaid
SCC849808055Medicare PIN
GA93BDNHVMedicare PIN
GA93BDGNKMedicare PIN
GA93BDFRCMedicare PIN