Provider Demographics
NPI:1104819630
Name:KORENMAN, ERIC S (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:S
Last Name:KORENMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4109
Mailing Address - Country:US
Mailing Address - Phone:413-447-2439
Mailing Address - Fax:413-447-2443
Practice Address - Street 1:725 NORTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4109
Practice Address - Country:US
Practice Address - Phone:413-447-2439
Practice Address - Fax:413-447-2443
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2048372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1104819630Medicaid
CT1104819630Medicaid
MAJ22676OtherMA BC/BS
NY02137819Medicaid
11046629OtherCAQH ID#
CT1104819630Medicaid
NY02137819Medicaid