Provider Demographics
NPI:1770012619
Name:KORO, KONSTANTIN (MD)
Entity Type:Individual
Prefix:
First Name:KONSTANTIN
Middle Name:
Last Name:KORO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KONSTANTIN
Other - Middle Name:VIKTOROVITCH
Other - Last Name:KOROTKOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1959 NE PACIFIC STREET, BOX 356100
Mailing Address - Street 2:UNIVERSITY OF WASHINGTON, DEPARTMENT OF PATHOLOGY
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC STREET, RM NE 110
Practice Address - Street 2:UNIVERSITY OF WASHINGTON, DEPARTMENT OF PATHOLOGY
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195
Practice Address - Country:US
Practice Address - Phone:206-616-6961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAFE60762184390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program