Provider Demographics
NPI:1770840563
Name:WEST, KORTNEY (MD)
Entity Type:Individual
Prefix:
First Name:KORTNEY
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2837
Mailing Address - Country:US
Mailing Address - Phone:610-546-2336
Mailing Address - Fax:
Practice Address - Street 1:4 PARK PLZ
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1398
Practice Address - Country:US
Practice Address - Phone:610-546-2336
Practice Address - Fax:484-328-6589
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD466232208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD466232OtherLICENSE