Provider Demographics
NPI:1043827355
Name:KORPITA, STEPHEN PAUL
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PAUL
Last Name:KORPITA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 STATE ROUTE 183
Mailing Address - Street 2:
Mailing Address - City:ROOTSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44272-9797
Mailing Address - Country:US
Mailing Address - Phone:330-325-0071
Mailing Address - Fax:330-325-0089
Practice Address - Street 1:3525 STATE ROUTE 183
Practice Address - Street 2:
Practice Address - City:ROOTSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44272-9797
Practice Address - Country:US
Practice Address - Phone:330-325-0071
Practice Address - Fax:330-325-0089
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6700930Medicaid