Healthcare Provider Details

I. General information

NPI: 1700852159
Provider Name (Legal Business Name): DR. PHILIP KONITS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2006
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2059 BALTIMORE BLVD
FINKSBURG MD
21048-1301
US

IV. Provider business mailing address

PO BOX 309
WESTMINSTER MD
21158-0309
US

V. Phone/Fax

Practice location:
  • Phone: 410-876-5148
  • Fax:
Mailing address:
  • Phone: 410-876-5149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0024321
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: