=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104819630
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC S. KORENMAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2005
-----------------------------------------------------
Last Update Date | 03/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 725 NORTH ST
-----------------------------------------------------
City | PITTSFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01201-4109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-447-2439
-----------------------------------------------------
Fax | 413-447-2443
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 725 NORTH ST
-----------------------------------------------------
City | PITTSFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01201-4109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-447-2439
-----------------------------------------------------
Fax | 413-447-2443
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 204837
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------