Provider Demographics
NPI:1841444916
Name:KORAH, REGY GEEVARGHESE (MD)
Entity type:Individual
Prefix:DR
First Name:REGY
Middle Name:GEEVARGHESE
Last Name:KORAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REGY
Other - Middle Name:RACHEL
Other - Last Name:GEEVARGHESE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:787 CORTARO DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6812
Mailing Address - Country:US
Mailing Address - Phone:813-634-2500
Mailing Address - Fax:813-634-3008
Practice Address - Street 1:787 CORTARO DR
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33573-6812
Practice Address - Country:US
Practice Address - Phone:813-634-2500
Practice Address - Fax:813-634-3008
Is Sole Proprietor?:No
Enumeration Date:2008-11-15
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066009A207R00000X
FLME103640207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000994700Medicaid
FLB5325ZMedicare PIN