Healthcare Provider Details

I. General information

NPI: 1417947847
Provider Name (Legal Business Name): STEPHEN JAMES KORN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 JUNIPER RD
SHARON MA
02067-3223
US

IV. Provider business mailing address

37 JUNIPER RD
SHARON MA
02067-3223
US

V. Phone/Fax

Practice location:
  • Phone: 781-718-0189
  • Fax: 781-784-3491
Mailing address:
  • Phone: 781-718-0189
  • Fax: 781-784-3491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number77338
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD10945
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: