Basic Information
| Provider Information | |||||||||
| NPI: | 1841303971 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOREN | ||||||||
| FirstName: | NATASHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 ARCH ST STE 260 | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443042200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303756590 | ||||||||
| FaxNumber: | 3303756593 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 ARCH ST STE 260 | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443042200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303756590 | ||||||||
| FaxNumber: | 3303756593 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 01/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 44888 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 11882743 | 05 | CO | MEDICAID |