Healthcare Provider Details

I. General information

NPI: 1841299641
Provider Name (Legal Business Name): PAUL C KONITZKY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 NOLTE DRIVE EXT
KITTANNING PA
16201-7159
US

IV. Provider business mailing address

2006 MAXWELL LN
MARS PA
16046-2136
US

V. Phone/Fax

Practice location:
  • Phone: 724-545-8000
  • Fax: 724-543-4370
Mailing address:
  • Phone: 724-816-1626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS012144
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: