Provider Demographics
NPI:1902868474
Name:KORT, JOSEPH FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:FRANCIS
Last Name:KORT
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 1:519 N ROCK ST
Mailing Address - Street 2:
Mailing Address - City:SHAMOKIN
Mailing Address - State:PA
Mailing Address - Zip Code:17872-6768
Mailing Address - Country:US
Mailing Address - Phone:570-648-6433
Mailing Address - Fax:570-648-0863
Practice Address - Street 1:519 N ROCK ST
Practice Address - Street 2:
Practice Address - City:SHAMOKIN
Practice Address - State:PA
Practice Address - Zip Code:17872-6768
Practice Address - Country:US
Practice Address - Phone:570-648-6433
Practice Address - Fax:570-648-0863
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025127E208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008852800001Medicaid
PA03024700OtherCAPITAL BLUE CROSS
PA105712Medicare ID - Type Unspecified
PA03024700OtherCAPITAL BLUE CROSS