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General NPI Number Information
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NPI Number | 1073950531
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Entity Type | Individual
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Provider Name | RILEY KONARA MD
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Gender | Male
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Dates
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Enumeration Date | 05/23/2013
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Last Update Date | 09/13/2021
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Provider Practice Location Address
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Address Line | KIMBOROUGH AMBULATORY CARE CENTER 2480 LLEWELLYN AVENUE
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City | FORT MEADE
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State | MD
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Zip | 20755
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Country | US
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Telephone | 301-677-8942
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Fax |
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Provider Business Mailing Address
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Address Line | 411 WHISPERING ELM LN
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City | MILLERSVILLE
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State | MD
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Zip | 21108-2184
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Country | US
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Telephone | 347-401-2984
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 28148
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | D87009
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License Number State | MD
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