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General NPI Number Information
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NPI Number | 1245855485
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Entity Type | Individual
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Provider Name | LYDIA KOROSHETZ MD
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Gender | Female
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Dates
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Enumeration Date | 06/13/2020
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Last Update Date | 06/10/2023
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Provider Practice Location Address
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Address Line | 3401 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-5103
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Country | US
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Telephone | 215-707-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 2037 MOUNT VERNON ST APT 2R
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City | PHILADELPHIA
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State | PA
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Zip | 19130-3224
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Country | US
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Telephone | 240-994-7929
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A186182
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MT220245
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License Number State | PA
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