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General NPI Number Information
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NPI Number | 1801880752
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Entity Type | Individual
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Provider Name | MARTIN ANTHONY KORKOWSKI MD
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Gender | Male
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Dates
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Enumeration Date | 09/07/2005
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Last Update Date | 03/18/2024
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Provider Practice Location Address
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Address Line | 44055 RIVERSIDE PARKWAY, SUITE 216
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City | LEESBURG
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State | VA
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Zip | 20176-5179
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Country | US
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Telephone | 703-858-1395
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Fax | 703-858-7468
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Provider Business Mailing Address
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Address Line | 224 D CORNWALL STREET NW STE 403
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City | LEESBURG
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State | VA
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Zip | 20176-2704
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Country | US
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Telephone | 703-737-6010
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Fax | 703-443-8643
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101048127
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License Number State | VA
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