Individual
COREY SCOTT KOENIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
79 SAYLES ST, SOUTHBRIDGE, MA 01550-1729
(508) 764-3200
(508) 764-9600
Mailing address
79 SAYLES ST, SOUTHBRIDGE, MA 01550-1729
(508) 764-3200
(508) 764-9600
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
72556
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
072556
TUFTS
MA
01
—
13730
HARVARD PILGRIM
MA
05
—
3066100
—
MA
Enumeration date
08/14/2006
Last updated
12/21/2011
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