Provider Demographics
NPI:1386634806
Name:KORNBLEUTH, STEVEN IRA (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:IRA
Last Name:KORNBLEUTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 CITY HALL PLZ
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3149
Mailing Address - Country:US
Mailing Address - Phone:781-662-8881
Mailing Address - Fax:781-662-3376
Practice Address - Street 1:1 CITY HALL PLZ
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3149
Practice Address - Country:US
Practice Address - Phone:781-662-8881
Practice Address - Fax:781-662-3376
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA156364207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
J19373OtherBCBS
0300301OtherUNITED HEALTHCARE
MA156364OtherSTATE LICENSE NUMBER
39444OtherFALLON
156364OtherTUFTS
401061OtherHARVARD PILGRIM
070012784OtherRAILROAD MEDICARE
2062239OtherAETNA
070012784OtherRAILROAD MEDICARE
39444OtherFALLON
BK5473878OtherDEA