Healthcare Provider Details

I. General information

NPI: 1912042946
Provider Name (Legal Business Name): FILOMENA R KOENIGSBERG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FILOMENA DIBIASI

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS STREET
BALTIMORE MD
21264-4435
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5000
  • Fax:
Mailing address:
  • Phone: 410-933-6423
  • Fax: 410-500-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA0307116
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR149099
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR149099
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: