Provider Demographics
NPI:1801880752
Name:KORKOWSKI, MARTIN ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:ANTHONY
Last Name:KORKOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:224 D CORNWALL STREET NW
Mailing Address - Street 2:STE 403
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2704
Mailing Address - Country:US
Mailing Address - Phone:703-737-6010
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:44055 RIVERSIDE PARKWAY, SUITE 216
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-5179
Practice Address - Country:US
Practice Address - Phone:703-858-1395
Practice Address - Fax:703-858-7468
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048127207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30016354550001Medicaid
VA010132029Medicaid
VA1801880752Medicaid
VAP00200904OtherRR MEDICARE
VA006876L19Medicare PIN