Healthcare Provider Details

I. General information

NPI: 1548497183
Provider Name (Legal Business Name): PHILIP KONITS MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 06/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2059 BALTIMORE BLVD
FINKSBURG MD
21048-1301
US

IV. Provider business mailing address

2059 BALTIMORE BLVD
FINKSBURG MD
21048-1301
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberD24321
License Number StateMD

VIII. Authorized Official

Name: MRS. SHARON STAUB
Title or Position: PRACTICE MANAGER
Credential: RN
Phone: 410-876-5148