Provider Demographics
NPI:1730124215
Name:COREN, HOWARD ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:ANDREW
Last Name:COREN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:233 OAK KNOLL RD
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482
Mailing Address - Country:US
Mailing Address - Phone:707-362-0403
Mailing Address - Fax:707-462-7846
Practice Address - Street 1:COUNTY OF MENDOCINO DEPARTMENT OF PUBLIC HEALTH
Practice Address - Street 2:1120 SOUTH DORA ST
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482
Practice Address - Country:US
Practice Address - Phone:707-472-2600
Practice Address - Fax:707-472-2773
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2021-09-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG28969207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G239690OtherBLUE SHIELD OF CALIFORNIA
CA00G289690Medicaid
CA5542977OtherCCN/FIRST HEALTH
CA5230656OtherAETNA PIN
CA680121024OtherBLUE CROSS OF CALIFORNIA
CA5542977OtherCCN/FIRST HEALTH
CA00G289696Medicare ID - Type Unspecified