Provider Demographics
NPI:1396706503
Name:KORETH, JOHN (MBBS DPHIL)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:KORETH
Suffix:
Gender:M
Credentials:MBBS DPHIL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 BINNEY ST
Mailing Address - Street 2:D1B 22
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6013
Mailing Address - Country:US
Mailing Address - Phone:617-632-2949
Mailing Address - Fax:617-632-5168
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:D1B 22
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6013
Practice Address - Country:US
Practice Address - Phone:617-632-2949
Practice Address - Fax:617-632-5168
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208706207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
208706OtherTUFTS
3616024OtherCIGNA
3600442OtherUNITED HEALTH CARE
3634386OtherAETNA US HEALTCARE
MAJ27417OtherBLUE CROSS BLUE SHIELD
MA2042941Medicaid
9348554OtherPRIVATE HEALTH CARE SYS
AA13671OtherHPHC DFCI ONLY
I09298Medicare UPIN
A37002Medicare ID - Type Unspecified