Provider Demographics
NPI:1093777542
Name:KONERDING, HAZLE S (MD)
Entity Type:Individual
Prefix:
First Name:HAZLE
Middle Name:S
Last Name:KONERDING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 FOREST AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1726
Mailing Address - Country:US
Mailing Address - Phone:804-282-0831
Mailing Address - Fax:804-288-7135
Practice Address - Street 1:7001 FOREST AVE STE 400
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1726
Practice Address - Country:US
Practice Address - Phone:804-282-0831
Practice Address - Fax:804-288-7135
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026447207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5940354Medicaid
070000322Medicare ID - Type Unspecified
VA5940354Medicaid