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General NPI Number Information
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NPI Number | 1548497183
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Entity Type | Organization
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Legal Business Name | PHILIP KONITS MD LLC
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Dates
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Enumeration Date | 06/22/2009
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Last Update Date | 06/22/2009
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Provider Practice Location Address
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Address Line | 2059 BALTIMORE BLVD
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City | FINKSBURG
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State | MD
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Zip | 21048-1301
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Country | US
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Telephone | 410-876-5148
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Fax | 410-876-5149
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Provider Business Mailing Address
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Address Line | 2059 BALTIMORE BLVD
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City | FINKSBURG
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State | MD
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Zip | 21048-1301
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Country | US
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Telephone | 410-876-5148
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Fax | 410-876-5149
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. SHARON STAUB
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Credential | RN
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Telephone | 410-876-5148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | D24321
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License Number State | MD
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