Provider Demographics
NPI:1700895976
Name:KORINCHAK, JEROME LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:LEE
Last Name:KORINCHAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1470 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-3501
Mailing Address - Country:US
Mailing Address - Phone:717-250-4260
Mailing Address - Fax:570-372-5766
Practice Address - Street 1:1000 ROUTE 522
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-8707
Practice Address - Country:US
Practice Address - Phone:570-372-5690
Practice Address - Fax:570-372-5766
Is Sole Proprietor?:No
Enumeration Date:2006-08-06
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025540E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA064208Medicare PIN
PAC33349Medicare UPIN
PA080186018Medicare PIN