Healthcare Provider Details

I. General information

NPI: 1295001386
Provider Name (Legal Business Name): SCOTT THOMAS KORFHAGEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 PHILADELPHIA DR
DAYTON OH
45406-1813
US

IV. Provider business mailing address

PO BOX 632317
CINCINNATI OH
45263-2317
US

V. Phone/Fax

Practice location:
  • Phone: 937-278-2612
  • Fax: 937-567-4163
Mailing address:
  • Phone: 717-263-5562
  • Fax: 717-263-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35.127757
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: