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NPI Code Detail

MEDICARE: REBECCA L KONKLE M.D.

MEDICARE: REBECCA L KONKLE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician59333MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1HV0026OTHERMAHARVARD PILGRIM
2J07532OTHERMABLUE CROSS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4059333OTHERMATUFTS

General Provider Information

NPI Number : 1366411449
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA L KONKLE M.D.
Provider Business Mailing Address
First Line : 75 MOUNT AUBURN ST
Second Line :
City : CAMBRIDGE
State : MA
Zip : 02138-4960
Country : US
Telephone Number : 617-495-4414
Fax Number : 617-495-8090
Provider Business Practice Location Address
First Line : 75 MOUNT AUBURN ST
Second Line :
City : CAMBRIDGE
State : MA
Zip : 02138-4960
Country : US
Telephone Number : 617-495-4414
Fax Number : 617-495-8090
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2006
Last Update Date : 05/03/2018

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Directions to “ REBECCA L KONKLE M.D.” Practice Location

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