Active NPI
Walter Joseph Koroshetz, MD
- Vascular Neurology Physician
- Boston, MA
National Provider Identifier
1255312211
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular Neurology Physician
- License
- 50968
- Practice address
- 55 Fruit St
VBK 915
Boston, MA 02114-2621 - Phone
- (617) 726-7413
- Fax
- (617) 726-2353
- NPI assigned
- Nov 8, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 50968 | MA | |
| Nephrology Physician | 207RN0300X | 50968 | MA | |
| Vascular Neurology Physician | 2084V0102X | 50968 | MA | Primary |
Addresses
Primary practice location
55 Fruit St
VBK 915
Boston, MA 02114-2621
Mailing address
PO Box 9142
Charlestown, MA 02129-9142
Phone (617) 724-0287
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| J05512 | Other | MA | BCBS MA |
| 050968 | Other | MA | TUFTS HEALTH PLAN |
| 3014916 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131408000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1255312211",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9142",
"city": "CHARLESTOWN",
"state": "MA",
"postal_code": "021299142",
"telephone_number": "617-724-0287",
"fax_number": "617-726-2894"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 FRUIT ST",
"address_2": "VBK 915",
"city": "BOSTON",
"state": "MA",
"postal_code": "021142621",
"telephone_number": "617-726-7413",
"fax_number": "617-726-2353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOROSHETZ",
"first_name": "WALTER",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-08",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MA",
"license": "50968",
"primary": false
},
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "MA",
"license": "50968",
"primary": false
},
{
"code": "2084V0102X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Vascular Neurology",
"state": "MA",
"license": "50968",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MA",
"identifier": "J05512",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HEALTH PLAN",
"identifier": "050968",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3014916",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.