Healthcare Provider Details

I. General information

NPI: 1609874692
Provider Name (Legal Business Name): KARL G KOENIG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 W BROAD ST STE A
RICHMOND VA
23294-3701
US

IV. Provider business mailing address

671 HIOAKS RD SUITE B
RICHMOND VA
23225
US

V. Phone/Fax

Practice location:
  • Phone: 804-673-2722
  • Fax: 804-282-5723
Mailing address:
  • Phone: 804-272-5814
  • Fax: 804-560-0232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number0101048551
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: