Provider Demographics
NPI:1952586018
Name:KORBLY, NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:KORBLY
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 1:101 PLAIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4829
Mailing Address - Country:US
Mailing Address - Phone:401-453-7560
Mailing Address - Fax:401-453-7573
Practice Address - Street 1:101 PLAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4829
Practice Address - Country:US
Practice Address - Phone:401-453-7560
Practice Address - Fax:401-453-7573
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD15036207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD712L/315601YBPGMedicare PIN