Individual
AVITAL ANGEL KORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
650 ALBANY ST, BOSTON, MA 02118
(617) 638-7330
Mailing address
11 JOHN ST, BROOKLINE, MA 02446-3719
(857) 364-7043
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
268831
MA
Other
Enumeration date
08/31/2016
Last updated
09/03/2016
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