Individual
DR. ELLEN M KORNMEHL
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
100 BLOSSOM STREET COX 301, RADIATION ONCOLOFY, BOSTON, MA 02114-2617
(617) 726-6050
(617) 726-3603
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
77524
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
077524
TUFTS HEALTH PLAN
MA
05
—
3109241
—
MA
01
—
J13779
BCBS MA
MA
Enumeration date
10/25/2005
Last updated
07/08/2007
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