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General NPI Number Information
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NPI Number | 1477689578
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Entity Type | Individual
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Provider Name | TIA RENE' KONZER D.O.
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Gender | Female
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 11/24/2015
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Provider Practice Location Address
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Address Line | 1900 RANDOLPH RD
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City | CHARLOTTE
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State | NC
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Zip | 28207-1122
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Country | US
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Telephone | 704-384-1246
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Fax | 704-384-6072
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Provider Business Mailing Address
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Address Line | 1900 RANDOLPH RD
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City | CHARLOTTE
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State | NC
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Zip | 28207-1122
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Country | US
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Telephone | 704-384-1246
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Fax | 704-384-6072
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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 | 5101016063
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License Number State | MI
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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 | 2009-01442
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 2009-01442
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License Number State | NC
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