Provider Demographics
NPI:1538275995
Name:KORTA, GLORIA (MD)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:
Last Name:KORTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 SWANTON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-2039
Mailing Address - Country:US
Mailing Address - Phone:781-729-1930
Mailing Address - Fax:781-729-1499
Practice Address - Street 1:77 SWANTON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-2039
Practice Address - Country:US
Practice Address - Phone:781-729-1930
Practice Address - Fax:781-729-1499
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55524207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3053474Medicaid
130283OtherHARVARD PILGRIM
93731OtherUS HEALTHCARE
055524OtherTUFTS
139591OtherHEALTHSOURCE
J08323OtherBLUE CROSS
93731OtherUS HEALTHCARE
MA3053474Medicaid