Provider Demographics
NPI:1821088931
Name:KOERNER, FREDERICK CARL (ME)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:CARL
Last Name:KOERNER
Suffix:
Gender:M
Credentials:ME
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:PATHOLOGY ASSOCIATES WRN
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-2967
Practice Address - Fax:617-726-7474
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA43527207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6169759Medicaid
MA043527OtherTUFTS HEALTH PLAN
MAJ02496OtherBCBS MA
A56675Medicare UPIN
MAJ02496OtherBCBS MA