Provider Demographics
NPI:1154437549
Name:GLORIA KORTA, MD, PC
Entity type:Organization
Organization Name:GLORIA KORTA, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KORTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-729-1930
Mailing Address - Street 1:77 SWANTON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-2039
Mailing Address - Country:US
Mailing Address - Phone:781-729-1930
Mailing Address - Fax:781-729-1499
Practice Address - Street 1:77 SWANTON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-2039
Practice Address - Country:US
Practice Address - Phone:781-729-1930
Practice Address - Fax:781-729-1499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55524261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
93731OtherUS HEALTHCARE
130283OtherHARVARD PILGRIM
J08323OtherBLUE CROSS
MA3053474Medicaid
055524OtherTUFTS
139591OtherHEALTHSOURCE
MA3053474Medicaid
=========OtherCOMMERCIAL
J08323Medicare ID - Type Unspecified