Individual
PHYLLIS J. KORNGUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, PHD
Contact information
Practice address
133 BROOKLINE AVE, BOSTON, MA 02215-3904
(617) 421-1000
(617) 421-6084
Mailing address
147 MILK ST, PROVIDER ENROLLMENT DEPARTMENT - 9TH FLOOR, BOSTON, MA 02109-4806
(617) 421-2508
(617) 421-3487
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
41281
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0015804
NEIGHBORHOOD HEALTH
MA
01
—
041281
TUFTS HEALTH PLAN
MA
05
—
3196097
—
MA
01
—
4814101
CIGNA
MA
01
—
AA43706
HARVARD PILGRIM
MD
01
—
J21332
BLUE CROSS BLUE SHIELD
MA
01
—
P00272094
RAILROAD
MD
Enumeration date
04/25/2006
Last updated
01/04/2012
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