Provider Demographics
NPI:1073950531
Name:KONARA, RILEY (MD)
Entity Type:Individual
Prefix:DR
First Name:RILEY
Middle Name:
Last Name:KONARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 WHISPERING ELM LN
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-2184
Mailing Address - Country:US
Mailing Address - Phone:347-401-2984
Mailing Address - Fax:
Practice Address - Street 1:KIMBOROUGH AMBULATORY CARE CENTER
Practice Address - Street 2:2480 LLEWELLYN AVENUE
Practice Address - City:FORT MEADE
Practice Address - State:MD
Practice Address - Zip Code:20755
Practice Address - Country:US
Practice Address - Phone:301-677-8942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE281482084P0800X
MDD870092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry