Provider Demographics
NPI:1740270487
Name:KORNMEHL, ELLEN M (MD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:M
Last Name:KORNMEHL
Suffix:
Gender:F
Credentials:MD
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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 1:100 BLOSSOM STREET COX 301
Practice Address - Street 2:RADIATION ONCOLOFY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2617
Practice Address - Country:US
Practice Address - Phone:617-726-6050
Practice Address - Fax:617-726-3603
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA775242085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ13779OtherBCBS MA
MA3109241Medicaid
MA077524OtherTUFTS HEALTH PLAN
MA3109241Medicaid
MA077524OtherTUFTS HEALTH PLAN