Provider Demographics
NPI:1861448698
Name:KORIAKIN, ARNOLD S (DO)
Entity Type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:S
Last Name:KORIAKIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 TRENWEST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3208
Mailing Address - Country:US
Mailing Address - Phone:336-970-5000
Mailing Address - Fax:336-970-5298
Practice Address - Street 1:3155 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-794-4372
Practice Address - Fax:336-659-2379
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2003003682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891226LMedicaid
NCP00715124OtherRR MEDICARE
NCP00715124OtherRR MEDICARE
NC240110Medicare PIN
NC2401100FMedicare PIN
NC2401100HMedicare PIN
NC2401100GMedicare PIN
F22095Medicare UPIN
NC2401100EMedicare PIN