Provider Demographics
NPI:1942240148
Name:MACHTAY, KORINA SHULEMOVICH (MD)
Entity Type:Individual
Prefix:
First Name:KORINA
Middle Name:SHULEMOVICH
Last Name:MACHTAY
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 1:2221 NOLL DR STE 2000
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-7614
Mailing Address - Country:US
Mailing Address - Phone:717-715-1001
Mailing Address - Fax:717-431-2321
Practice Address - Street 1:2221 NOLL DR STE 2000
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-7614
Practice Address - Country:US
Practice Address - Phone:717-715-1001
Practice Address - Fax:717-431-2321
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052565L207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA544473OtherBLUE SHIELD
OH0064450Medicaid
OHH064490Medicare PIN
OH0064450Medicaid
544473Medicare ID - Type Unspecified